2021 KCSCEP Central Summer Camp Shoals Summer Camp Flinn Summer Camp

Overbrook Summer Camp June 2-July 30, 2021

Enrollment Packet Packet contains:

Program Overview 2021 Enrollment Form

Student Internet & Telecommunications Acceptable Use Policy Handbook Acceptance Form

Child Medical Form

Please read all information carefully and fill out the enrollment form completely. Please return enrollment form by email or FAX.

Return completed enrollment form to:

Kanawha County Schools Community Education Program 142 Marshall Avenue, Dunbar, WV 25064

304-766-0378 FAX (304) 766-0389 KCSCEP@mail.kana.k12.wv.us

Website: kcscep.kana.k12.wv.us

Welcome to KCSCEP Summer Camp 2021

Serving Kanawha County Schools students who were in Kindergarten through Fifth Grade in 2020-2021 school year. Thank you for choosing KCSCEP Summer Camp for your summer care. Please see the Family Handbook for complete policies and procedures information.

Summer Third Base Operation Hours Summer Third Base 2021 runs Monday through Friday from June 2 through July 30. The hours are 7:00 a.m. to 5:40 p.m. Summer Third Base will be closed on June 21 for West Virginia Day and July 5 for Independence Day observances. There will be no discount for those days.

Application Please complete the application, leaving no blank spaces. (For example, if your child has no allergies, write in “none” or “N/A”.) List anyone other than parents or guardians allowed to sign your child in or out. An address and phone number is required for each authorized person. You must also provide the name and policy num-ber of your child’s health insurance provider. Please note that a photo ID is required for anyone picking your child up for the first time or if the site director in charge does not recognize the person, parents included. This is for your child’s safety. Sign and date places indicated on the form. For the Student AUP which gives permis-sion for students to use Summer Camp iPads or the computer lab, please list all your children on one form. To start camp on June 2, your enrollment must be received by May 28. If your child is enrolled after May 28, he/she will have a start date of June 7 or after.

Fees There is a $30 non-refundable registration fee per family required for enrollment, due the first day of attendance. (Enroll by May 7 and receive a $10 discount on registration.) The weekly summer camp tuition fees are $135 for 1 child, $235 for 2 children, and $335 for 3 children, which are due on the first day of attendance each week. There is a late fee of $5.00 per day due until tuition is paid in full. For the first week of camp, June 2-4, the rate will be prorated $80 for 1 child, $140 for 2 children and $200 for 3 children.

Be advised that all accounts must be paid in full by Friday, in order for your child to return the following Monday. We accept cash, check, money order, and credit/debit card. Make checks payable to KCSCEP (Kanawha County Schools Community Education Program). We also offer automatic ACH payments Tuition Express. See the Site Director for more information or to enroll. There is a $25.00 fee for returned checks or Tuition Express payments. There is a $2 per transaction fee for payment with a debit/credit card. CONNECT or LINK is accepted. You must present a current certificate identifying the specific KCSCEP summer camp as “PROVIDER” on the first day your child attends or you will pay the weekly fee until we have this docu-mentation. (Note: If you are returning to a Third Base when school resumes, be sure to have your certificate switched back to that Third Base site.)

Late Pick Up Fees Pick up is 5:40 p.m. After this time, there is a $1.00 per minute late fee assessed and payable at time of pick up. The Site Director may waive this fee if the reason for late pick up is due to issues such as traffic situations or medical emergencies that are beyond your control. Please call the Site Director if you are running late so that the staff will know someone is on their way. Otherwise, if your child has not been picked up by closing time, staff will begin calling people on your pick up list. If your child is not picked up and we cannot reach you or anyone on your list, we will call the authorities. Please note that on the fifth occurrence of late pick up that has not been waived, you will be given a two-week dismissal notice for services. All fees must be paid by Friday in order for your child to return to Summer Third Base the following Monday.

Check In & Check Out Procedure/PROCARE All children MUST be checked in and out by the parent or designated person each day. NO drop-offs. A child will not be released without your authorization. Send a note or call in the event a non-designated person will be picking up your child. A photo ID will be required. In keeping with our COVID-19 procedures, parents or other pick up persons may not enter the building. Meals Breakfast, lunch and an afternoon snack will be provided. However, you may send snacks with your child that may be eaten during snack time. (No candy or sodas, please.)

Medication KCSCEP staff do not administer over the counter medication. Prescription medications may only be given by trained staff. Please see the summer camp site director if your child will need to have prescription medication ad-ministered during summer camp. We follow KCS policies for dispensing prescription medications, which includes

having a doctor’s order and having medication in the original bottle or container it was dispensed in with clear and precise dosing directions. Child Medical Form KCSCEP Summer Camps are licensed through West Virginia Department of Health and Human Resources. They require that we have a Child Medical Form for each child enrolled in Summer Camp. A form for your child’s physi-cian to complete is provided in this packet, or you may bring a comparable form from your child’s physician. This form is required for enrollment. Program Overview KCSCEP Summer Camp offers your child a safe, structured environment, with many activities to keep them en-gaged. There will be a variety of recreational and educational activities. Swimming will be offered and the cost for swimming is included in your tuition. You must sign a permission form for swimming and other field trips. Discipline Rules will be posted. Staff will review expectations with the children. The program operates under the guidelines of Kanawha County Schools and follows the same discipline code of conduct. We are not required to follow KCS IEPs or 504s. All students are expected to listen to and respect the staff. Failure to follow these rules or staff instruction may result in your child being suspended from the program, with no refund of fees. Continued behavioral problems may result in expulsion from the program. Parents will be made aware of problems or poor behavior early on so as to avoid these drastic measures. Behavior plans or other interventions may be put in place to assist your child(ren) to be successful in our program. Dress Code The Kanawha County Schools dress code (copy on file) will be followed for summer camp. Please review this poli-cy. Because we will be playing outside and doing arts and crafts and other projects, we recommend students wear old play clothes and shoes. We recommend sending an extra change of clothes with your child. Students may wear tennis shoes or sandals with backs, but tennis shoes are required for outside play. NO FLIP FLOPS OR ATHLETIC SLIDES. Please note that children may bring flip flops/slides on swim days to be worn at the pool only. A t-shirt will be provided to your child for swim days. Please indicate your child’s shirt size on the appli-cation form where noted. What to Bring Each child should bring a backpack or bag, labeled with his or her name, to hold personal belongings. On swim days, please send your child’s bathing suit and a towel. Please send sunscreen for your child to apply under staff supervision for outside play. Label all personal belongings. Students may NOT bring electronic devices (i.e., iPads, tablets) If your child has a cell phone, it must be kept in his or her backpack. You may call the summer camp phone if you need to speak with your child. For safety reasons, students may not use personal devices or cameras to take photos of themselves or other students during camp. KCSCEP is not responsible for any lost, stolen or broken items. Attendance In order to better help us plan for activities and have adequate supplies and staffing, please complete the summer camp attendance sheet. Let us know which weeks your child or children will not attend due to family vacations, special camps for sports, music or other interests, etc. Contact Information You may reach the summer camps at the numbers below, or call the KCSCEP office at 304-766-0378. Central Elementary School: 900 Helene Street., St. Albans, WV 25177 304-722-0226 Shoals Elementary: 100 Dutch Road, Charleston, WV 25302 304-348-1900 Flinn Elementary:2006 McClure Parkway, Sissonville, WV 25312 304-348-1960 Overbrook Elementary: 218 Oakwood Road, Charleston, WV 25314 304-348-6179 Questions/Grievances Please speak with your camp’s site director if you have any questions or concerns during summer camp. If you feel your questions or concerns have not been resolved by the director, please contact the KCSCEP office at 304-766-0378 or email us at KCSCEP@mail.kana.k12.wv.us.

Kanawha County Schools Community Education Program

2021 SUMMER CAMP Child Care Family Registration Form

A new form must be completed each program year. One form per family. Photo ID required for child pick up. Child(ren) must have been enrolled in grade K through 5 in 2020-2021 school year to enroll in Summer Camp. Registration Fee is $30 per family, non-refundable.

Placement is subject to availability at desired site. Submission of enrollment/fee is not a guarantee of placement. Registration process may take up to 5 days. You will be notified if your child(ren) may start or will be on a wait list.

Check the Summer Camp (SC) you are registering for: Central SC Shoals SC Flinn SC Overbrook SC Have you enrolled a child in a KCSCEP childcare program before? No Yes If yes, which site? ____________________________

Name of Child(ren) Child #3 Full Name Child #1 Full Name Child #2 Full Name

Parent/Guardian Information This section is to be completed by the LEGAL mother, father, or guardians of the child(ren) and serves as the emergency contact/authorized pick up infor-mation. You must provide the name, physical address (no PO Boxes) and a telephone number for each parent/guardian in order for your Enrollment to be accepted. Copies of all legal documents pertaining to custody, restraining orders, etc. must be on file with the Site Director. (All documents may be re-viewed by the KCS legal department at any time.) Please do not repeat this information under Other Emergency Contact and Authorized Pick Up Persons.

Legal Parent/Guardian 1: Mother Father Guardian/Foster Parent - Relationship to Child _______________________________________________

First Name: _____________________ M.I.: ________ Last Name: ________________________________ Date of Birth: ____________________

Physical Address: _____________________________________ City: _________________________________ State: ____ Zip Code: ___________

Occupation/Employer: __________________________ Work Address: ____________________________________________________________

Home Landline Phone: _______________________ Cell Phone: ___________________________ Work Phone: ___________________________

Email address: ___________________________________ Marital Status: Married Divorced Separated Single

Driver’s License or State ID #: ___________________________ Last 4 Digits of Social Security #:_________________________

Mark all that apply:

Child lives with this parent This parent is limited in or not authorized to pick up — see court papers.

Legal Parent/Guardian 2: Mother Father Guardian/Foster Parent - Relationship to Child _______________________________________________

First Name: _____________________ M.I.: ________ Last Name: ________________________________ Date of Birth: ____________________

Physical Address: _____________________________________ City: _________________________________ State: ____ Zip Code: ___________

Occupation/Employer: __________________________ Work Address: ____________________________________________________________

Home Landline Phone: _______________________ Cell Phone: ___________________________ Work Phone: ___________________________

Email address: ___________________________________ Marital Status: Married Divorced Separated Single

Driver’s License or State ID #: ___________________________ Last 4 Digits of Social Security #:_________________________

Mark all that apply:

Child lives with this parent This parent is limited in or not authorized to pick up — see court papers.

Account Responsibility

Please indicate the payment type for this account: Private Pay CONNECT or LINK Parents/guardians are responsible for the account unless otherwise noted. Please indicate who is responsible for payment if it is someone other than legal parents/guardians. If you are receiving assistance through CONNECT or LINK, you are responsible for any co-pay fees. You must have your cer-tificate showing your child(ren) is covered the first day of attendance or you will be billed the private pay rate. If CONNECT or LINK deny pay-ment or you become ineligible, you will be charged the private pay rate for any week not covered. Name(s) of Responsible Party: _______________________________________________________________________________________________

I agree to follow all KCSCEP policies, procedures and requirements.(Enrollment indicates acceptance) SIGNATURE:______________________________________________ Date: _____________________________________ (Parent/Guardian)

OFFICE USE ONLY

Date received ________ Processed By: ____________ Entered in Procare _______ Parent notified: _______ Director notified: _______ Enrolled: ________ Wait List: ________

Information About Child or Children

Photography/Video and Sound Recording

If you do not wish your child(ren) to be photographed or be recorded by video and/or audio devices, please indicate below. Photographs and audiovisual recordings are used for security purposes and/or for KCS publications/website to inform parents about our activities. By not initialing, you are giving per-mission for them to be photographed and/or audio/video taped. I do not want my child(ren) to be photographed. Initials ___________ I do not want my child(ren) to be recorded by video and/or audio devices. _________

Child #1: First Name: _______________________ Middle: ______________________ Last Name: ________________________

Name Child Prefers to be called: ______________ Grade 2020-2021: ______________ Age: _____________ T-Shirt Size: ______

Date of Birth: _____________________________ Gender: Male Female Last 4 digits of SSN# :_____________

Name of Child’s School: ____________________________________________________________________________________

Allergies (if none, write “none”): ________________________________________________________________________________

List any medical conditions, medications, and/or special attention your child may require (if none, write “none”):

_________________________________________________________________________________________________________

Must be filled out completely.

Health Insurance Provider: ____________________________________ Policy Number: _________________________________

Physician Name: ____________________________________________ Phone: _______________________________________

Physician Address: _________________________________________________________________________________________

Dentist Name: _______________________________________________ Phone: _______________________________________

Dentist Address: ___________________________________________________________________________________________

Child #2: First Name: _______________________ Middle: ______________________ Last Name: ________________________

Name Child Prefers to be called: ______________ Grade 2020-2021: ______________ Age: _____________ T-Shirt Size: ______

Date of Birth: _____________________________ Gender: Male Female Last 4 digits of SSN# :_____________

Name of Child’s School: ____________________________________________________________________________________

Allergies (if none, write “none”): ________________________________________________________________________________

List any medical conditions, medications, and/or special attention your child may require (if none, write “none”):

_________________________________________________________________________________________________________

Must be filled out completely.

Health Insurance Provider: ____________________________________ Policy Number: _________________________________

Physician Name: ____________________________________________ Phone: _______________________________________

Physician Address: _________________________________________________________________________________________

Dentist Name: _______________________________________________ Phone: _______________________________________

Dentist Address: ___________________________________________________________________________________________

Child #3: First Name: _______________________ Middle: ______________________ Last Name: ________________________

Name Child Prefers to be called: ______________ Grade 2020-2021: ______________ Age: _____________ T-Shirt Size: ______

Date of Birth: _____________________________ Gender: Male Female Last 4 digits of SSN# :_____________

Name of Child’s School: ____________________________________________________________________________________

Allergies (if none, write “none”): ________________________________________________________________________________

List any medical conditions, medications, and/or special attention your child may require (if none, write “none”):

_________________________________________________________________________________________________________

Must be filled out completely.

Health Insurance Provider: ____________________________________ Policy Number: _________________________________

Physician Name: ____________________________________________ Phone: _______________________________________

Physician Address: _________________________________________________________________________________________

Dentist Name: _______________________________________________ Phone: _______________________________________

Dentist Address: ___________________________________________________________________________________________

Other Emergency Contacts & Authorized Pickup Persons

DO NOT list parents/guardians from page 1! Parents/Guardians are always contacted first in an emergency. You must list at least one person who is not a parent/guardian who can be contacted in the event of an emergency or illness if the parents/guardians can-not be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the cen-ter, able to take responsibility for the child(ren) in case the parents/guardians cannot be contacted and should be at least 18 years old.

You must provide the name, physical (no PO Boxes) address and a telephone number for each emergency contact in order for your Enrollment to be accepted.

Emergencies/First Aid

KCSCEP staff has permission to administer first aid and/or transport my child in the event of an emergency. _____________________________________________ _____________________________ SIGNATURE OF PARENT/GUARDIAN DATE

Contact/Pickup #1 First Name: ____________________________ MI: _______ Last Name: _______________________________

Physical Address (Street, City, State Zip): ________________________________________________________________________

Occupation/Employer: ____________________________________ Email: _____________________________________________

Home Phone: ______________________ Cell Phone: _________________________ Work Phone: _________________________

Relationship to Child: ________________________________________________________________________________________

Please mark all that apply. This person will not be authorized unless you check the box.

Emergency Contact

Authorized to pick up the following children: ___________________________________________________________

Contact/Pickup #2 First Name: ____________________________ MI: _______ Last Name: _______________________________

Physical Address (Street, City, State Zip): ________________________________________________________________________

Occupation/Employer: ____________________________________ Email: _____________________________________________

Home Phone: ______________________ Cell Phone: _________________________ Work Phone: _________________________

Relationship to Child: ________________________________________________________________________________________

Please mark all that apply. This person will not be authorized unless you check the box.

Emergency Contact

Authorized to pick up the following children: ___________________________________________________________

Contact/Pickup #3 First Name: ____________________________ MI: _______ Last Name: _______________________________

Physical Address (Street, City, State Zip): ________________________________________________________________________

Occupation/Employer: ____________________________________ Email: _____________________________________________

Home Phone: ______________________ Cell Phone: _________________________ Work Phone: _________________________

Relationship to Child: ________________________________________________________________________________________

Please mark all that apply. This person will not be authorized unless you check the box.

Emergency Contact

Authorized to pick up the following children: ___________________________________________________________

Contact/Pickup #4 First Name: ____________________________ MI: _______ Last Name: _______________________________

Physical Address (Street, City, State Zip): ________________________________________________________________________

Occupation/Employer: ____________________________________ Email: _____________________________________________

Home Phone: ______________________ Cell Phone: _________________________ Work Phone: _________________________

Relationship to Child: ________________________________________________________________________________________

Please mark all that apply. This person will not be authorized unless you check the box.

Emergency Contact

Authorized to pick up the following children: ___________________________________________________________

Please ask the director for an Extra Contact/Pick Ups form if needed. Should you need to send someone not on these forms to pick up your child(ren), please send a note or call the site director to give verbal permission. The person picking up must show a photo ID.

2021 KCSCEP Summer Camp Permission Form and Agreements

I hereby grant permission for my child(ren) to use all the play equipment and participate in all of the activities, including water activities and swimming, associated with Summer Camp. I will send sunscreen for my child to apply daily, under staff supervision, for outdoor activities.

KCSCEP may transport my child(ren) to a swimming pool if one is not on site. I will send a towel and a bathing suit for my child on swim days. I will complete and sign a field trip permission form.

I understand that my child must have tennis shoes for outside play and flip flops or athletic slides may only be worn at the swimming pool on pool day.

I understand the KCS Community Education Program or its staff is not responsible for anything that may occur as a result of false infor-mation given by a parent or legal guardian at the time of enrollment.

I agree that the KCS Community Education Program and its staff are released of any liability in connection with medical treatment and una-voidable accidents.

I agree to check my child IN and OUT each day to ensure safety for my child(ren), other children enrolled in the program and the staff.

I understand the KCSCEP will not be responsible for any lost, stolen or broken items that my child/ren may bring from home. Cell phones and personal electronic devices are not permitted.

I have read and understand the explanation of how discipline will be handled and that the program operates under the guidelines of Kana-wha County Schools and follows the same discipline code of conduct. I understand that KCSCEP does not follow Kanawha County Schools IEPs or 504s.

Call 304-766-0378 if you have any questions about the above statements before signing this form.

PARENT/GUARDIAN APPROVAL: As the parent or legal guardian of the child(ren) named on this enrollment form, I approve of and agree to abide by all of the conditions stated above in order to participate in the KCSCEP Summer Camp.

Parent/Guardian Signature: _________________________________________ Date: _______________________

CONNECT OR LINK PARTICIPANTS KCSCEP Summer Camp accepts CONNECT and LINK. It is the parent/guardian’s responsibility to get the child care certificate from CONNECT or LINK. You must have a child care certificate on file with us that lists the specific KCSCEP summer site and covers the first day that your child(ren) attends or you will be billed the weekly private pay rate. If we receive a notice from CONNECT or LINK say-ing you have become ineligible, your child will not be able to attend past the date of eligibility unless you pay the private pay rate or we re-ceive a notice saying your coverage has been reinstated. You are responsible for paying your co-pay amount on the first day of each week or the late payment fee of $5 per day will apply. If your account is not paid in full by Friday, your child(ren) may not return to the program until the account is paid in full. If CONNECT or LINK deny payment or you become ineligible, you will be charged the private pay rate for any week not covered. Any unpaid CONNECT or LINK co-pay fees will be reported to CONNECT or LINK. You must sign time sheets confirming your child’s attendance so that we may bill Connect. Failure to sign time sheets will result in you being billed the Private Pay rate for any weeks we do not have a signed time sheet for. If your child(ren) plans to return to Third Base when school starts, be sure to get your certificate changed back from summer camp to the Third Base site.

NOTICE OF NONDISCRIMINATION

Applicants for admission and employment, students, parents, employees, and sources of referral of applicants for admission and employment are hereby notified that the Kana-wha County School District does not discriminate on the basis of race, color, religion, national origin, sex, age, or disability in admission or access to, or treatment or employment in, its programs and activities. Any person having inquiries concerning the Kanawha County School District’s compliance with the regulations implementing Title IX or Section 504 is directed to contact: Title IX: Title IX Coordinator, Kanawha County Board of Education, 200 Elizabeth Street, Charleston, WV 25311-2119, phone 348-1379; Section 504: Sec-tion 504 Coordinator, Kanawha County Board of Education, 200 Elizabeth Street, Charleston, WV 25311-2119, phone 348-1366. These persons have been designated by the Kana-wha County School District to coordinate the efforts to comply with the regulations implementing Title IX and Section 504.

You must have submitted completed enrollment forms and been approved before your child(ren) may attend. When approved, the registration fee will be billed to your account and due the first day of attendance. Return your completed enrollment forms to the KCSCEP office by mail or in person. If mailed or emailed to us, we will contact you by phone or email to confirm receipt of the enrollment form and to inform you whether your child(ren) may begin attending the program or will be on a wait list. If you have any questions, please call or email the KCSCEP office. (Contact information listed below.)

PRIVATE PAY PARTICIPANTS Payment is due on the first day your child(ren) attends each week, or the late payment fee of $5 per day will apply. It is a weekly fee; there are no daily rates. If your account is not paid in full by Friday, your child(ren) may not return to the program until the account is paid in full. You may pay for weeks in advance. We accept cash, as well as check or money order made payable to KCSCEP. Summer camp sites will also have other payment options through Tuition Express. See your Site Director for more information. After 2 returned checks or Tuition Express payments, cash or money orders will be required for payment. Summer Camp 2021 Weekly Fees: $135 - 1 child, $235 - 2 children, $335 - 3 children.

For Summer Camp 2021

APPENDIX B KANAWHA COUNTY SCHOOLS

INTERNET & TELECOMMUNICATIONS ACCESS ACCEPTABLE USE AGREEMENT

FOR ELEMENTARY STUDENTS

USE OF TECHNOLOGY RESOURCES WITHIN KANAWHA COUNTY SCHOOLS IS A PRIVILEGE, NOT A RIGHT.

USER RESPONSIBILITIES

I understand my responsibility for using the Internet and other online resources;

therefore, I will only use the computer/iPad as directed by my teacher;

I will only use the computer when an adult is in the room;

I will only use good manners when using the computer/iPad;

I will not give out any personal information about myself or others, such as my name, address, telephone number, or

age while on the computer;

I understand that all passwords are to kept secret;

I will not log on to a computer/iPad using another person’s username or password;

I will not bypass or attempt to bypass any school, county or state filtering system;

I will not post or send information to harass or bully another person;

I will only use the school-provided email account while at school;

I will only use school-sponsored blogs, wikis, web 2.0+ tools, social networking sites and online groups as part

of any educational activity;

I will only use appropriate Internet sites as directed by my teacher;

I will tell my teacher or other adult if I accidentally access an inappropriate site;

I understand that I must adhere to the mandates of West Virginia’s Board of Education Policy 2460 - Educational Purpose and Acceptable Use of Electronic Resources, Technologies and the Internet.

I cannot use the Internet in school until I have completed the Acceptable Use Training, and my parents (or guardian) and

I have signed and returned the KCS Acceptable Use form.

NOTE: A complete copy of Policy 2460 may be obtained from http://wvde.state.wv.us/policies/

I understand my responsibility for using software legally; therefore,

I will not give, lend, sell or copy any software found on school computers or the Internet, unless I have printed

permission from the copyright owner;

I will not install any software on school computers/iPads without teacher permission;

I will not install or add any device to a school computer or network;

I understand the importance of using both print and non-print information in a lawful manner; therefore,

I will not copy information received in any form and say that it is my own work;

I will accurately cite all sources of information;

I understand that the use of computer networks is a privilege, not a right;

therefore,

I will follow the school’s computer use rules

I will not attempt to bypass system security or change settings without teacher permission;

I will not bypass or attempt to bypass any school, county or state filtering system;

I will not tamper with the network or computers/iPads;

I will not damage or destroy any technology equipment;

I will not go into anyone else’s files or use anyone else’s password;

I will not download or listen to music from the Internet unless directed to do so by the teacher;

I will not use any non-school email address while at school

I will not play any non-educational game on a school computer

Providing false or misleading information when applying for computer access, or violating any of the above rules, will cancel my privileges and may result in further disciplinary action, including reimbursement for damage and computer recovery costs, and/or expulsion from

For Summer Camp 2021—Use one form for all children in the family

School Name: ____________________________________________________________________________

Student: I have read or had read to me and consent to the rule and responsibilities listed above. I

have never had my computer privileges restricted or revoked by any other school.

Student WVEIS number:

Student Name (Please print): ______________________________________________________________

Student Signature: ________________________________________________________________________

Date: / / Grade: _________________________________

Parent or Guardian: I have read and discussed this form with my child. I understand that it is the responsibility of my child to restrict his/her use to the classroom projects assigned. I accept full responsibility for supervision if and when my child is using computers in a setting other than school. I also understand that the teacher cannot be held responsible for intentional infractions of the above rules by my child.

_____ I give permission for my child to access the Internet in school.

_____ I do not give permission for my child to access the Internet in school. _____ I give permission for my child to access the Internet in school ONLY FOR Testing Purposes

Student’s first name Student’s photo

Student’s last name Student in group photo

SCHOOL INTERNET WEB SITE STUDENT INFORMATION

I hereby give permission to use the following information on the school and/or district web sites (initial all that you approve):

Parent / Guardian’s Name: (Please print):

Parent / Guardian Signature: Date: / /

**Optional -Parent Email: (will not be shared with 3rd parties without permission)

***NOTE: This form will be kept on file in the school listed above. It will not be transferred to another school.

KCSCEP 2021 Summer Camp Attendance

Child/Children Name: _________________________________________________ Program Site: _______________________________________________________

Summer Camp Week 2021 Plan to Attend Will Not Attend

June 2-4

June 7-11

June 14-18

June 21-25 (closed June 21 WV Day observance)

June 28 - July 2

July 5 - July 9 (closed July 5 Independence Day observance)

July 12-16

July 19-23

July 26-31

During the summer, attendance numbers will fluctuate as families take weekly vacations or students participate in such activi-ties as other special interests camps. In order to help us with planning and purchasing supplies, it is helpful to have an esti-mate of how many children will be attending each week. For each week of camp listed below, please mark the appropriate box to indicate if you plan for your child(ren) to attend or if you know your child(ren) will not due to vacations or other reasons. If you have more than one child and their schedules may be different, you can note that in the box. (Ex: Jane will attend but John will be at soccer camp that week.) We understand that plans may change, but this gives us a better idea of how many to expect weekly. Thank you.

2021-2022 KCSCEP Family Handbook

I have received a copy of the 2021-2022 KCSCEP Family Handbook. I understand that I, along with my child’s other parent/guardian if applicable, am responsible for reading and following the information contained in this handbook.

Name of Child/Children: ___________________________________________

KCSCEP site name: ________________________________________________

Parent name (please print): _________________________________________

Parent Signature: __________________________________________________

Date: ___________________________________________________

William J. Raglin Community Center 142 Marshall Avenue Dunbar, WV 25064

304-766-0378 Fax: 304-766-0389 Jennifer L. Mathis, Director

Kanawha County Schools Community Education Program