2020-2021

ENROLL NOW! BEFORE & AFTER SCHOOL CARE

BEFORE SCHOOL CARE(Katharine D. Malone, Byram, Dwyer, Stony Brook, Allamuchy & Birchwood)

AFTER SCHOOL CARE Long Valley (Flocktown-Kossmann Elementary)Rockaway Twp. (Katharine D. Malone, Dwyer,

Stony Brook, Dennis B. O’Brien & Birchwood)Byram, Wharton & Allamuchy

10% discount for additional siblingsTUITION Before & After School Care Program

BEFORE SCHOOL CAREStony Brook, Birchwood (Begins at 7:00 am)

5 days per week $160/month4 days per week $130/month3 days per week $100/month

Katharine D. Malone, Dwyer School (Begins at 7:00 am) & Byram Lakes (Begins at 6:45 am)

5 days per week $185/month4 days per week $155/month3 days per week $130/month

AFTER SCHOOL CAREAllamuchy Township

5 days per week $300/month4 days per week $270/month3 days per week $255/month2 days per week $240/monthBEFORE CARE $145/month

Flocktown-Kossman School5 days per week $315/month4 days per week $285/month3 days per week $240/month2 days per week $200/month

Rockaway Twp, Byram Lakes & Wharton Schools5 days per week $300/month4 days per week $270/month3 days per week $255/month2 days per week $240/month

Additional Fees: 1/2 days are included in monthly payment. • Full days (Scheduled vacation weeks, holidays, etc) $25 per day

SEND REGISTRATION FORMS TO DEBBIE@RANDOLPHYMCA.ORG OR FAX 973.366.80251

Tax ID # 22-16012592020/2021

QUESTIONS ABOUT ROCKAWAY TWP., BYRAM, WHARTON & ALLAMUCHY? Contact Lynn

Molitoris 973.366.1120 Ext. 16lynn@randolphymca.org

QUESTIONS ABOUT LONG VALLEY? Contact Cindy Smith

cindy@randolphymca.org 908.689.9312

ALL BILLING QUESTIONS? Contact Debbie Popek 973.366.1120 Ext.13

debbie@randolphymca.org

WELCOME!If you were enrolled in 2019/2020 Before/After School Care, you will be credited 1 1/2 months.

Please note that this application cannot be accepteduntil all information is complete, as required by the New Jersey State Bureau of Licensing.

Please be sure to write legibly, especially phone numbers. Applications which cannot be read clearly will be returned.

If any part of the application is incomplete, the entire application and deposit will be returned to you andregistration will be delayed.

THIS PROGRAM BEGINS ON THE FIRST DAY OF SCHOOL AND RUNS TO THE LAST DAY OF SCHOOL.

• The YMCA requires that all Before/After School Care participants send the first and last month’s tuition.

• Your application and deposit MUST BE RECEIVED BY US NO LATER THAN AUGUST 17, 2020. If we do not have your application and deposit, your child

CANNOT START ON THE 1st DAY OF SCHOOL.

• PLEASE NOTE THE FOLLOWING NEW LATE PAYMENT INFORMATION It is extremely important to receive your before/after school program payments on time. These payments are needed to run the program at our site for the coming month. Please read your Tuition Agreement carefully. Your payment for the upcoming month is due by the first day of that month. Example: Your November payment is due by November 1st.

• 10% discount for additional siblings!

REMINDER:• The following fees MUST be included with

your completed application: 2 month’s deposittobecreditedtothefirstandlastmonth of the program. If you were enrolled in 2019/2020 Before/After School Care, you will be credited 1 1/2 months.

• If your payment is received after the third day of the month, a late fee of $15 will be assessed to your account. If your payment is not received by the tenth day of the month, an additional late fee of $20 will be assessed to your account.

More than two late payments during a school year will result in automatic drafts.

• If an unforeseen financial difficulty arises, please call Debbie’s office 973.366.1120 Ext. 13, so that payment arrangements can be made.

• No credits will be issued for absences from the Before/After School Program. Tuition is payable monthly at a flat rate as indicated on your Tuition Agreement.

• Cell phones, video games, trading cards, toys, action figures, etc. are not allowed at the program. The YMCA will not be held responsible for these valuable items.

• ROCKAWAY TWP., BYRAM, WHARTON & ALLAMUCHY: Lynn Molitoris 973.366.1120 Ext. 16 or lynn@randolphymca.org

• LONG VALLEY: Cindy Smith 908.689.9312 or cindy@randolphymca.org

• BILLING: Debbie Popek 973.366.1120 Ext. 13 or debbie@randolphymca.org

The Randolph YMCA requires the signature of BOTH parents on ALL before/after school program documents. The only exceptions will be the following: • If a parent is deceased• If a parent does not have custodial rights (this must be

indicated on the application)• If the child is in the custody of a legal guardian (this must

be indicated on the application)

**THE FOLLOWING MUST BE INCLUDED WITH COMPLETED APPLICATION**

2 month deposit to be credited to the firstandlastmonthoftheprogram

(If you have already secured your child’s spot with a 1-month

deposit, only 1 additional month is required to register at this time)

WE WISH YOUR CHILD A

WONDERFUL YEAR AT OUR BEFORE/AFTER SCHOOL PROGRAM! Please be sure to keep this brochure as well as other parent information literature as a reference to the rules of our Before/After School Program.

Healthy U is a collaborative partnership between the New Jersey YMCA State Alliance and the Horizon Foundation for New Jersey with the goal of combating childhood obesity through nutrition education, physical education and family involvement. The Randolph

Tax ID # 22-1601259

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PARENT RESPONSIBILITIESPICK UPParents are required to pick up their children no later than 6:00 pm. All parents MUST sign out their children. There will be no exceptions! This is a necessary procedure for the protection of your child.

If a child is not picked up by 6:00 p.m., the parent will be charged a fee of $1.00 for every minute or part thereof that you are late. This fee will be billed to you and payment must be made upon receipt of the billing. If late pick-ups become a habit (3 or more times) your child may be excluded from the after school program.

It is the parent’s responsibility to make arrangements for their child’s pick up. However, in the event of an emergency, please make arrangements with a friend or relative to pick up your child. Those individuals must be listed on your application. If someone other than a person listed on the application will be picking up your child, you must notify the director in writing in advance. If we do not have advanced notification from you, your child WILL NOT be released until a parent can be reached. Please note that any individuals who will be picking up your child will be asked for identification before your child is released to them. Please be sure to inform them of this policy.

Please be sure to keep us informed of any changes in your place of employment or business phone numbers. We MUST be able to reach you in the event of an emergency.

Daily EventsCalendars are issued monthly by the site director. Please be sure your child comes prepared each day. Children may be asked to wear sneakers for outdoor or gym play.

ABSENCEParents should call their child’s site director to report anabsence from the Before/After School Program. THIS CALL MUST BE MADE NO LATER THAN 10:00 A.M. ON THE DAYOF THE ABSENCE. The YMCA must be notified of any changesin your child’s schedule IN WRITING. Do not rely on thedirector to relay this information.

TERMINATIONIf you wish to terminate your child’s attendance at the program, the YMCA must be notified IN WRITING at leasttwo weeks prior to your child’s last day. FAILURE TO DOSO WILL RESULT IN YOUR DEPOSIT NOT BEINGREFUNDED.

ADDITIONAL ACTIVITIESIf your child has an activity in the school building (scouts,enrichment classes, etc), the director MUST be informed INWRITING at least one day ahead that your child will beleaving the program at a specific time and returning at aspecific time. You must indicate the location of the activitywithin the building. If this is an ongoing activity, you maysend in a letter specifically stating all dates that the activitywill take place. IT IS NOT THE RESPONSIBILITY OF OURSTAFF TO ESCORT YOUR CHILD TO OR FROM ANYACTIVITY. Upon your child’s return to the program, yourchild will pick up on activities as they are in progress. Specialarrangements cannot be made to make up homework time orany other missed activity. If your child goes directly fromtheir class or is signed out of the Before/After SchoolProgram to attend an outside activity (scout trip, doctor’sappointment, etc.) your child MAY NOT RETURN to theprogram.

* If more than one sibling is enrolled in the program, they both must be signed out and taken home together.

PAYMENTTHE BEFORE/AFTER SCHOOL PROGRAM RATES ARE LISTED ON YOUR TUITION AGREEMENT.

Parents are responsible for making monthly payments by thefirstdayofeachmonth. These payments must be mailed in, called in to x13 or can be withdrawn monthly. THEY CANNOT BE HANDED TO OUR STAFF AT THE PROGRAM.

Please mail payments to:

Randolph YMCAAttn: Debbie Popek14 Dover Chester Road Randolph, NJ 07869

Or you may make your payment by phone using Mastercard, Visa, AMEX or Discover by calling Debbie x13

WEATHER RELATED ISSUESWe will follow your school’s schedule for holidays, vacations and half days (scheduled early dismissals)

PROGRAM WILL NOT BE HELD WHEN:• The school is closed due to inclement weather• The school is dismissed early due to inclement weather• No Before School Care when the school has a delayed

opening-After School Care will still be held

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BEHAVIORA log will be kept at the program documenting any behavior situations. You will be asked to sign this log to confirm notification of any behavior problem. Please note our Discipline Policy below. Parents need to handle problems maturely and rationally away from other children. Please set up a conference if a problem persists.

DISCIPLINE POLICYWe expect that we will have students who are occupied in creative, physical, and mental activities throughout the day. We are sure this will prevent them from becoming involved in inappropriate behavioral situations. We encourage you, as a parent, to discuss with your child appropriate social behavior to circumvent a discipline problem. We are positive that a situation requiring the director to terminate attendance by a disruptive child will not arise. Fighting, swearing, disrespect to the director, staff, or another child, abusive language, physical abuse, stealing, etc., are actions contrary to proper YMCA behavior goals and will be looked upon as cause for termination with no refund of program fees.

In the event of inappropriate actions by a participant in the program, they will be given a warning. If the action continues, the child will sit out of the activity going on. All behavioral situations will be documented in a log set up for each child. Parents will be informed of all entries into this log and will be required to sign indicating that they have been made aware of the entry.

Upon continuation of the problem, the parent will be called and an in person conference will be set up if the issue cannot be resolved during the phone conversation. Should theproblem continue beyond this, the child will be given a day off from the program and a continuing problem will be cause for termination from the program.

PROACTIVE ACTIONS THAT CAN BE TAKEN IN ORDER TO PREVENT EXPULSION• Redirect the child from negative behavior

• Reassess classroom environment, activities & supervision

• The use of positive language & methods while disciplining

• Praise appropriate behaviors

• Consistently apply consequences if rules are broken

• Child will be given time to regain control

• Parent/guardian will be given literature of other resources

regarding methods of improving behavior

EXPULSION POLICYUnfortunately, there are situations when we have to expel a child from our program either on a short term or permanent basis. We will do everything possible to work with the family of the child (ren) in order to prevent this policy from being enforced. IMMEDIATE CAUSES FOR EXPULSION• The child is at risk of causing serious injury to other children or himself/herself• Parent threatens physical or intimidating actions toward staff members or other parents/children• Parent exhibits verbal abuse to staff or other parents/ children in front of enrolled children

PARENTAL ACTIONS FOR CHILD EXPULSION• Failure to pay/habitual lateness in payments• Failure to complete required forms including child’s

immunization records• Habitual tardiness when picking up your child• Verbal abuse to staff• Other

CHILD’S ACTIONS FOR EXPULSION• Failure of child to adjust after a reasonable amount of

time.• Uncontrollable tantrums/angry outbursts.• Ongoing physical or verbal abuse to staff or other

children.• Excessive biting• Inappropriate language & inappropriate behavior as

determined by staff

SCHEDULE OF EXPULSIONIf after the remedial actions above have not worked, the child’s parent/guardian will be advised verbally and in writing about the child’s or parents behavior warranting an expulsion. An expulsion action is meant to be a period of time so that the parent/guardian may work on the child’s behavior or to come to an agreement with the center.The parent/guardian will be informed regarding the length of the expulsion period.The parent/guardian will be informed about the expected behavioral changes required in order to return to the center.The parent/guardian will be given a specific expulsion date that allows the parent sufficient time to seek alternate child care (approximately one to two weeks notice depending on risk to other children’s welfare or safety). Failure of the child/parent to satisfy the terms of the plan may result in permanent expulsion from the center.

A CHILD WILL NOT BE EXPELLED If a child’s parent (s):

•Reported abuse or neglect occurring at the center.•Questioned the center regarding policies and procedures.

•Without giving the parent sufficient time to make other child care arrangements.

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FULL DAY PROGRAMS 8:00am-6:00 pm

Full day programs are for days when school has a scheduled closing all day (i.e. teacher’s convention, winter break, etc.) will be held at the Randolph YMCA (14 Dover Chester Road, Randolph NJ 07869)

• DO NOT DROP OFF YOUR CHILD EARLIER THAN 7:55 am• We must have a minimum of 15 children to run a full day program• Your child must be brought into the building where the full day program is located and checked

in with a director • DO NOT drop them off at the front door

PICK-UPIf your child will be picked up by someone other than a custodial parent, a note to this effect MUST BE SENT IN EACH DAY. Directors may ask anyone picking up a child, even a parent, for identification. This is for your child’s protection.

SWIMMINGAt least one bathing suit and towel should be sent in each day. Please discuss proper locker room behavior with your child. We have a predominantly female staff and do not always have direct locker room supervision by our Full Day Program Staff (lifeguards supervise from the pool deck). Please stress that there should be no running, yelling, slamming of lockers or throwing clothing in the locker rooms. Children are required to dress quickly, as our swim times are fit in around the swim class schedule. If we are unable to get the children dressed and out of the locker room quickly, we will not be permitted to use the pool during full day programs.

MEDICATIONIf your child needs to take medication at the full day programs, you must complete a “Permission to Administer Medication” form which can obtained from the YMCA. MEDICATION MUST COME IN ITS

ORIGINAL CONTAINER.

As we have different directors each day who may not know your child, please be sure to give the director daily any instructions regarding specific medical situations, i.e chronic illnesses, allergies, earplugs needed for swimming, etc.

FOOD• Please be sure your child eats a nutritious

breakfast before arriving. We have an active program throughout the day.

• Please be sure to send your child with a lunch and drink each day. Lunches must be non-perishable or in an insulated bag. Please do not send foods that need to be heated or microwaved.

• Candy and soda are not permitted at our program. • Please do not send in money for vending machine

snacks. This applies to use of the machines at lunch time as well.

• We will provide a morning and afternoon snack.

Cell phones, video games, toys, trading cards, collectibles, iPods or any other valuable items are NOT ALLOWED at the YMCA Full Day Program. The YMCA will not be responsible for the safety of these items.

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TUITION Before & After School Care Program

BEFORE SCHOOL CARE at Stony Brook, Birchwood & Dennis B. O’Brien School begins at 7:00 amCIRCLE DAYS: M T W Th F

5 days per week $160/month4 days per week $130/month3 days per week $100/month

at Katharine D. Malone, Dwyer School (7:00 am) & Byram Lakes (6:45 am)

CIRCLE DAYS: M T W Th F5 days per week $185/month4 days per week $155/month3 days per week $130/month

AFTER SCHOOL CAREat Allamuchy TownshipCIRCLE DAYS: M T W Th F

5 days per week $300/month4 days per week $270/month3 days per week $255/month2 days per week $240/monthBEFORE CARE $145/month

at Flocktown-Kossman SchoolCIRCLE DAYS: M T W Th F

5 days per week $315/month4 days per week $285/month3 days per week $240/month2 days per week $200/month

at Rockaway Twp, Byram Lakes & Wharton SchoolsCIRCLE DAYS: M T W Th F

5 days per week $300/month4 days per week $270/month3 days per week $255/month2 days per week $240/month

Additional Fees: 1/2 days are included in monthly payment. Full days (Scheduled vacation weeks, holidays, etc) $25 per day.

Child’s Name _______________________________________________________

Mailing Address ___________________________________________________

City, State & Zip __________________________________________________

Date of Birth ______________________________________

School _______________________________________________________________

Amount ____________________________

I hereby give the Randolph YMCA permission to charge my credit card for all expenses due for the Before & After School Care Program September 2019-June 2020.

MasterCard Visa AMEX Discover

________________________________________________________________________________________Credit Card #

______________________________________ ______________________________________Expiration Date CVV Code

______________________________________________________________________________Cardholder’s Signature

_____________________________________________________ ____________________________ Phone # Date

Randolph YMCA Credit Card Agreement1. The Randolph YMCA Before & After School Care Program Credit Card Agreement is a continuous payment plan. I understand that this payment plan will remain in effect for as long as I have my child(ren) enrolled in the YMCA Before & After School Care Program, or the authorization granted to the YMCA has been revoked.

2. It is my understanding that if I wish to terminate or change my payment in any way, I must give the YMCA thirty (30) days written notice and that all charges will continue to accrue during the 30-day period.

3. Should my bank for any reason not honor any payment/credit transaction, I realize that I am still responsible for the payment.

Signature ___________________________________________________________________________

Date _____________________________________

10% discount for additional siblings

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2020/2021

YOU CAN EMAIL THIS FORM TO DEBBIE@RANDOLPHYMCA.ORG OR FAX TO 973.366.8025 ATTN: DEBBIE

Tax ID # 22-1601259

EMERGENCY CONTACTS AND PICKUP AUTHORIZATIONS IN CASE OF AN EMERGENCY OR SNOW CLOSING AND A PARENT CANNOT BE REACHEDIn addition to parents, ONLY those on the below list will be allowed to pick up a child from program. Please list all additional persons authorized to pick up your child. No child will be released without emergency verbal/written permission. Please make sure that the individuals on this list are aware that they may be called in an emergency to pick up your child. You are welcome to add or to delete from this list at any time; please indicate if a non-custodial parent has limits on visitation or pick up. If a non-custodial parent has been denied visitation or has limited visitation by court order, a copy of the order must be given to the YMCA.

Contact Information PLEASE CIRCLE NUMBER OF DAYS AM CARE M T W Th F PM CARE M T W Th F

SCHOOL ____________________________________________________________________

I GIVE PERMISSION THAT PHOTOS TAKEN DURING PROGRAM ACTIVITIES MAY BE USED IN YMCA PROGRAM MATERIAL.

YES I give the YMCA permission NO I do not give the YMCA permission

Parent/Guardian 1 Signature ______________________________________________ Printed Name _________________________________________________________ Date ____________________

Parent/Guardian 2 Signature _______________________________________________ Printed Name __________________________________________________________ Date __________________

Parent/Guardian 1: ______________________________________________________

Home Address ____________________________________________________________

City, State, Zip ____________________________________________________________

Cell Phone _________________________________________________________________

Home Phone ______________________________________________________________

Place of Employment ____________________________________________________

Address _________________________________________________________

City, State & Zip ______________________________________________

Email ___ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

Parent/Guardian 2:______________________________________________________

Home Address ____________________________________________________________

City, State, Zip ____________________________________________________________

Cell Phone _________________________________________________________________

Home Phone ______________________________________________________________

Place of Employment ____________________________________________________

Address _________________________________________________________

City, State & Zip ______________________________________________

Email ___ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

Child’s Name_______________________________________________________________________________________ Gender M / F

Birthday ____________________________________ Grade (as of 9/2020) _____________________

Parental Custody (if applicable) _______________________________________________________________

Allergies ____________________________________________________________________________________________________________________________

Contact/Relationship______________________________________________

Cell # ______________________________________________________

Home # ____________________________________________________

Work # ____________________________________________________

Contact/Relationship______________________________________________

Cell # ______________________________________________________

Home # ____________________________________________________

Work # ____________________________________________________

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Health History This application must be signed by both parents.

ALLERGIES

Food: ________________________________________________________________

Medications: _______________________________________________________

________________________________________________________________________If medications needs to be taken during the program, you must complete a Medication Authorization Form & submit it to the director.

Dietary Restrictions: _____________________________________________

BEHAVIOR ISSUES

__________________________________________________________________

__________________________________________________________________

Current medical, mental or psychological condition pertinent to routine care of participant including any current treatment care _________________________________________________________________________

_______________________________________________________________________________

PLEASE RESTRICT FROM THE FOLLOWING ACTIVITIES

__________________________________________________________________

__________________________________________________________________

PLEASE DESCRIBE ANY PAST MEDICAL TREATMENT THAT THE PARTICIPANT HAS RECEIVED

__________________________________________________________________

__________________________________________________________________

Insurance Carrier: ___________________________________________

Insurance Policy #: __________________________________________

Participant’s Physician: ____________________________________

Physician’s Phone #: ________________________________________

Hospital Preference: _________________________________

Parent/Guardian Authorization:This health history is correct as far as I know and the person described herein has my permission to engage in all program activities, except the ones noted by myself or physician. In the event of an emergency and I cannot be reached, I hereby give permission to the physician selected by the director to hospitalize, to secure proper treatment for, to order injection, anesthesia or surgery for my child as named above.

Parent/Guardian 1 Signature: _________________________ Date _________

Printed Name: ____________________________________________________________

Parent/Guardian 2 Signature: ________________________ Date _________

Printed Name: ____________________________________________________________

FOR THE PHYSICIANAlthough not required, it is the responsibility of the parent/guardian to have your child examined by a physician prior to their attendance at the after school program. If an examination is performed, please have the physician sign below.

I have examined the child described herein and have reviewed the health history. it is my opinion that he/she is physically able to engage activities except as noted below.

Child’s Name: ______________________________________________________

Physician’s Signature: ___________________________________________

Address: ____________________________________________________________

City:_________________________________State:_______ Zip:_____________

Phone #: __________________________________ Date: _________________

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Child’s Name ________________________________________________________ School ____________________________________________

EMAIL DEBBIE@RANDOLPHYMCA.ORG OR FAX TO 973.366.8025

MEDICATION ADMINISTRATION POLICYThis policy was written to encourage communication between the parent, the child’s health care provider and the YMCA to assure maximum safety when giving medication to a child during the time the child is attending Randolph YMCA programs in the absence of a parent/guardian.

Assuring the health and safety of all children at our YMCA programs is a team effort by the staff, family, and health care provider. This is particularly true when medication is necessary during the child’s participation in a program. Therefore, an understanding of each of our responsibilities, policies and procedures concerning medication administration is critical to meeting that goal.

The YMCA staff will not be able to treat all individuals with a particular impairment in an identical manner. Within the program, there may be a basis for distinguishing among individuals, and it will be the YMCA’s duty to determine the needs of each individual, its impact upon others in regard to health or safety, or if it would result in an undue burden that is of significant difficulty or expense.

GUIDING PRINCIPLES• Parents/guardians must have completed a Health Screening Form for their

child(ren) under 18.

• All minor children under the age of 18 enrolled in a YMCA program must

have all Randolph YMCA medical forms appropriate for their program and

individual medical condition completed and on file with the YMCA prior to

the child(ren) participation in the program.

• All medical information on file with the YMCA will be kept on a

confidential, “need to know” basis. Under no circumstances are

employees to discuss the medical information of any child(ren) in their

program(s) with anyone other than their supervisor, the parent/guardian

of the child(ren) and their healthcare provider.

• It is the parent/guardian’s responsibility to keep the YMCA informed of

any changes to their child(ren) medical situation.

• It is the parent/guardian’s responsibility to keep the YMCA informed and

up-to-date on all emergency contact information.

• It is the parent/guardian’s responsibility to ensure that all medications

are not expired

• If a YMCA employee is informed by a child’s parent/guardian of a

condition requiring medication, that employee must then contact their

supervisor. Employees are not to dispense any medication to a child(ren)

in their program(s) without a signed “Permission to Give Medication” form.

• Training in the administration of medication, such as EpiPen

Administration, will be given to YMCA employees who work with children

in compliance with all guidelines of the training agency approved by the

State of New Jersey and the Randolph YMCA.

PROCEDURESIn the event that it is necessary to administer medication to a child, the following guidelines and procedures shall be followed:

1. Whenever possible, it is best that medication be given at home. Dosing ofmedication can frequently be done so that the child receives medication priorto going to the YMCA, and again when returning home and/or at bedtime. The parent/guardian is encouraged to discuss this possibility with the child’shealth care provider.

2. The first dose of any medication should always be given at home and withsufficient time before the child returns to the YMCA program to observe thechild’s response to the medication given. When a child is ill due to acommunicable disease that requires medication as treatment, the health careprovider may require that the child be on a particular medication for 24hours before returning to child care/program. This is for the protection ofthe child who is ill as well as the other children in child care/program.

3. Medication will only be given when medically necessary and ordered bythe child’s health care provider and with written consent of the child’sparent/legal guardian. A “Permission to Give Medication” form is anAppendix to this policy and will hereafter be referred to as Permission Form. All information on the Permission Form must be completed before themedication can be given.

Only originals of Permission Form with parent/guardian signature will beacceptable. A signed original Permission Form must be on file for eachmedication that is to be dispensed to the child. Copies of the blankPermission Form can be duplicated or requested from the YMCA.

4. Medications given in any YMCA program will be administered by a staffmember designated by the applicable Program Director. It is theresponsibility of the Program Director to inform the designated staff memberof the child’s health needs related to the medication and ensure that theyhave had training in the safe administration of medication. All medicationdispensed must be documented. A single staff person per shift should beallowed to dispense the medicine at each location. (There may be confusionabout dispersal if more than one person is providing the medication.) Thedesignated staff person must be certified in First Aid and CPR for theProfessional Rescuer including AED.

PRESCRIPTION MEDICATIONSAny prescription medication brought to the YMCA must be specific to the

child who is to receive the medication, in its original container, have a child-resistant safety cap, and be labeled with the appropriate information as follows:• Prescription medication must have the original pharmacist label that

includes the pharmacists phone number, the child’s full name, name of the health care provider prescribing the medication, name and expiration date of the medication, the date it was prescribed or updated, and dosage, route, frequency, and any special instructions for its administration and/or storage. It is suggested that the parent/guardian ask the pharmacist to provide the medication in two containers, one for home and one for use at the site.

• In the case of a child requiring an EpiPen for allergies, two EpiPens in their original containers must be supplied by parent/guardian for storage at the site.

• Inhalers must be kept on the child’s person or in a designated location as determined by YMCA staff and must be self administered.

• An Action Plan signed by your child’s doctor must be included if your child requires an EpiPen or inhaler.

STAY AT HOME POLICYThe Randolph YMCA follows the NJ Department of Health and Senior Services guidelines for all staff and program participants who are ill. These guidelines are:• Parents are asked to keep their children home, and staff members should remain home if they are sick. Anyone with flu like illness should stay at home for 7 days or 24 hours after symptoms resolve, whichever is longer.

• Flu like symptoms are fever of 100 degrees or more, a sore throat or cough

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OVER THE COUNTER MEDICATIONSOver the counter (OTC) medications will only be given when medically necessary and ordered by the child’s health care provider OR with written consent of the child’s parent/legal guardian. A “Permission to Give Medication” form must be completed before medication can be given.

1. OTC medications must have the child’s full name on the container, and the manufacturer’s original label with dosage, route, frequency and any special instructions for administration and storage, and expiration date must be clearly visible.Examples of OTC medications that may be given include:

• Antihistamines

• Decongestants

• Non-aspirin fever reducers/pain relievers

• Cough suppressants

2. All medications will be stored:

• Inaccessible to children• In a separate container labeled that it is Medicine Storage• Separate from staff medications and first aid supplies• Under proper temperature control• A small lock box will be used in the refrigerator to hold

medications requiring refrigeration. If off-site, an ice chest/cooler will be used in place of a refrigeration

• In cases where immediate use may be necessary for medication to be carried on the child’s person, i.e. EpiPen and/or inhaler, written documentation of this medical need must be provided by the health care provider including written documentation that the child is capable of self-medication (up to age 18)

IF IT IS NECESSARY TO ADMINISTER MEDICATION TO A CHILD IN THE EVENT OF A LIFE THREATENING EMERGENCY, THE FOLLOWING PROCEDURES SHALL BE FOLLOWED:The Randolph YMCA Allergy Action Plan is in place for all children with allergies necessitating the administration of epinephrine (EpiPen or EpiPen Junior). In all instances of administration of epinephrine, EMS will be called immediately. The Parent/Guardian will also be notified immediately following the call to EMS.

PROTOCOL IS AS FOLLOWS• EpiPen will be on the child’s person and will be self-administered• If necessary, YMCA staff will assist the child with EpiPen administration• In the event the child is unable to, trained YMCA staff will administer

The Randolph YMCA follows the YMCA of the USA’s recommendation for all program participants to self- manage and self-administer medication for diabetes. Local legislation restricts such services to the parent or a medical professional.

Unused or expired medication will be returned to the parent/guardian when it is no longer needed or be able to be used by the child. EpiPen will be returned to the parent/guardian upon the child/children leaving the program at the end of the program cycle. EpiPen will not be kept by the YMCA for longer than one year. At the end of one year, new medical forms including prescription(s) from the health care provider must be provided to the YMCA.

A “Permission to Give Medication” form is included as an appendix to this policy.

Information exchange between the parent/guardian and YMCA staff about medication that a child is receiving should be shared when the child is brought to and picked-up from the YMCA. Parents/guardians should share with the staff any problems, observations, or suggestions that they may have in giving medication to their child at home, and likewise with the staff from the YMCA to the parent/guardian.

Confidentiality related to medications and their administration will be safeguarded by the YMCA Program Director and staff.

Parent/guardian will read and have an opportunity to discuss the content of this policy with the Program Director. The parent signature on this policy is an indication that the parent accepts the guidelines and procedures listed in this policy, and will follow them to safeguard the health and safety of their child. Parent/guardian will receive a copy of the signed policy.

RANDOLPH YMCA “PERMISSION TO GIVE” MEDICATIONPart I-TO BE COMPLETED BY THE PARENT/GUARDIAN

I hereby request and authorize Randolph YMCA personnel to administer medication as directed by our physician. I agree to release and hold harmless the Randolph YMCA and any of their officers, staff members or agents from lawsuit, claim, demand or action etc., against them for administering prescribed medication.

Participant _____________________________________________________________________________________________ Birthday __________________________________________

Parent/Guardian Signature _________________________________________________________________________ Date _______________________________________________

Phone # ____________________________________________________________ Name of Medication ________________________________________________________________

Reason for medication ____________________________________________________________________ Times to be taken _________________________________________

Dosage (must be consistent with product label) ____________________________________ Given How? _________________________________________________

Special Instructions ___________________________________________________________Adverse effects of medication ______________________________________

For the safety of all participants, medication will be kept in a secure location and dispensed by designated staff only, including over-the-counter medications. The only exceptions to this rule are inhalers and EpiPens.

Part II-FOR STAFF ONLY Signed copy of Randolph YMCA Medication Administration Policy on file Part I of this form is complete including signatures Prescription medication is properly labeled and its original packaging by pharmacist Medication to be given and physician order is consistent OTC medication is its original container with manufacturer’s dosage clearly visible

Randolph YMCA Director’s Signature _______________________________________________________________________________________ Date __________________________________________ 10

Dear Families,

In keeping with the New Jersey’s Child Care Center Licensing Requirements, we are obligated to provide you, as the parent of a child enrolled at our center/site, with the informational statement. The statement highlights, among other things, your right to visit and observe our site at any time without having to secure prior permission, the center’s obligation to be licensed and to comply with licensing standards, and the obligation of all citizens to report suspected child abuse/neglect/exploitation to the State Child Abuse Hotline 1 (877) NJ ABUSE

Enclosed within this registration packet are the following:

• Information to Parents Document• Policy on the Release of Children • Policy on the Management of Communicable Diseases• Positive Discipline Policy• Expulsion Policy• Technology, Communications & Social Media Policy

I have read and received a copy of the information/policies listed above. MUST BE SIGNED BY BOTH PARENTS

Please Print

Name of Child ___________________________________________________________ School/Site _____________________________________________________

Parent/Guardian 1 Name ______________________________________________________ Signature _____________________________________________

Parent/Guardian 2 Name ______________________________________________________ Signature _____________________________________________

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Department of Children and FamiliesOffice of Licensing

INFORMATION TO PARENTS

Under provisions of the Manual of Requirements for Child Care Centers (N.J.A.C. 3A:52), every licensed child care center in New Jersey must provide to parents of enrolled children written information on parent visitation rights, State licensing requirements, child abuse/neglect reporting requirements and other child care matters. The center must comply with this requirement by reproducing and distributing to parents and staff this written statement, prepared by the Office of Licensing, Child Care & Youth Residential Licensing, in the Department of Children and Families. In keeping with this requirement, the center must secure every parent and staff member’s signature attesting to his/her receipt of the information.

Our center is required by the State Child Care Center Licensing law to be licensed by the Office of Licensing (OOL), Child Care & Youth Residential Licensing, in the Department of Children and Families (DCF). A copy of our current license must be posted in a prominent location at our center. Look for it when you’re in the center.

To be licensed, our center must comply with the Manual of Requirements for Child Care Centers (the official licensing regulations). The regulations cover such area as: physical environment/life-safety; staff qualifications, supervision, and staff/child ratios; program activities and equipment; health, food and nutrition; rest and sleep requirements; parent/community participation; administrative and record keeping requirements; and others.

Our center must have on the premises a copy of the Manual of Requirements for Child Care Centers and make it available to interested parents for review. If you would like to review our copy, just ask any staff member. Parents may view a copy of the Manual of Requirements on the DCF website at http://www.nj.gov/dcf/providers/licensing/laws/CCCmanual.pdf or obtain a copy by sending a check or money order for $5 made payable to the “Treasurer, State of New Jersey,” and mailing it to: NJDCF, Office of Licensing, Publication Fees, PO Box 657, Trenton, NJ 07646-0657.

We encourage parents to discuss with us any questions or concerns about the policies and program of the center of the meaning, application, or alleged violations of the Manual of Requirements for Child Care Centers. We will be happy to arrange a convenient opportunity for you to review and discuss these matter with us. If you suspect our center may be in violation of licensing requirements, you are entitled to report them to the Office of Licensing toll free at 1 (877) 667-9845. Of course, we would appreciate you bringing these concerns to our attention, too.

Our center must have a policy concerning the release of children to parent or people authorized by parents to be responsible for the child. Please discuss with us your plans for your child’s departure from the center.

Our center must have a policy about administering medicine and health care procedures and the management of communicable diseases. Please talk to us about these policies so we can work together to keep our children healthy.

Our center must have a policy concerning the expulsion of children from enrollment at the center. Please review this policy so we can work together to keep your child in our center.

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Parents are entitled to review the center’s copy of the OOL’s Inspection/Violation Reports on the center, which are available soon after every State licensing inspection of our center. If there is a licensing complaint investigation, you are also entitles to review the OOL’s Complaint Investigation Summary Report, as well as any letters of enforcement or other actions taken against the center during the current licensing period. Let us know if you wish to review them and we will make them available for your review or you can view them online at https://data.nj.gov/childcare_explorer.

Our center must cooperate with all DCF inspections/investigations. DCF staff may interview both staff members and children.

Our center must post its written statement of philosophy on child discipline in a prominent location and make a copy of it available to parents upon request. We encourage you to review it and to discuss with us any questions you may have about it.

Our center must post a listing or diagram of those rooms and areas approved by the OOL for the children’s use. Please talk to us if you have any questions about the center’s space.

Our center must offer parents of enrolled children ample opportunity to assist the center in complying with licensing requirements; and to participate in and observe the activities of the center. Parents wishing to participate in the activities or operations of the center should discuss their interest with the center director, who can advise them of what opportunities are available.

Parents of enrolled children may visit our center at any time without having to secure prior approval from the director or any staff member. Please feel free to do so when you can. We welcome visits from our parents. Our center must inform parents in advance of every field trip, outing, or special event away from the center, and must obtain prior written consent from parents before taking a child on each such trip.

Our center is required to provide reasonable accommodations for children and/or parents with disabilities and to comply with the New Jersey Law Against Discrimination (LAD), P.L. 1945, c. 169 (N.J.S.A. 10:5-1 et seq.), and the Americans with Disabilities Act (ADA), P.L. 101-336 (42 U.S.C. 12101 et seq.). Anyone who believes the center is not in compliance with these laws may contact the Division on Civil Rights in the New Jersey Department of Law and Public Safety for information about filing a LAD claim at (609) 292-4605 (TTY users may dial 711 to reach the New Jersey Relay Operator and ask for (609) 292-7701), or may contact the United States Department of Justice for information about filing an ADA claim at (800) 514-0301 (voice) or (800) 514-0383 (TTY).

Our center is required, at least annually, to review the Consumer Product Safety Commission (CPSC), unsafe children’s products list, ensure that items on the list are not at the center, and make the list accessible to all staff and parents and/or provide parents with the CPSC website at https://www.cpsc.gov/Recalls. Internet access may be available at your local library. For more information call the CPSC at (800) 638-2772.

Anyone who has reasonable cause to believe that an enrolled child has been or is being subjected to any form of hitting, corporal punishment, abusive language, ridicule, harsh, humiliating or frightening treatment, or any other kind of child abuse, neglect, or exploitation by any adult, whether working at the center or not, is required by State law to report the concern immediately to the State Central Registry Hotline, toll free at (877) NJ ABUSE/(877) 652-2873. Such reports may be made anonymously. Parents may secure information about child abuse and neglect by contacting: DCF, Office of Communications and Legislation at (609) 292-0422 or go to www.state.nj.us/dcf/.

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Policy on the Release of Children

Each child may be released only to the child’s parent(s) or person(s) authorized by the parent(s) to take the child from the center and to assume responsibility for the child in an emergency if the parent(s) cannot be reached.

If a non-custodial parent has been denied access, or granted limited access, to a child by a court order, the center shall secure documentation to that effect, maintain a copy on file, and comply with the terms of the court order.

If the parent(s) or person(s) authorized by the parent(s) fails to pick up a child at the time of the center’s daily closing, the center shall ensure that: 1. The child is supervised at all times; 2. Staff members attempt to contact the parent(s) or person(s) authorized by the parent(s); and 3. An hour or more after closing time, and provided that other arrangements for releasing the child to his/her parent(s) or person(s) authorized by the parent(s), have failed and the staff member(s) cannot continue to supervise the child at the center, the staff member shall call the 24-hour State Central Registry Hotline 1-877-NJ-ABUSE (1-877-652-2873) to seek assistance in caring for the child until the parent(s) or person(s) authorized by the child’s parent(s) is able to pick-up the child.

If the parent(s) or person(s) authorized by the parent(s) appears to be physically and/or emotionally impaired to the extent that, in the judgment of the director and/or staff member, the child would be placed at risk of harm if released to such an individual, the center shall ensure that: 1. The child may not be released to such an impaired individual; 2. Staff members attempt to contact the child’s other parent or an alternative person(s) authorized by the parent(s); and 3. If the center is unable to make alternative arrangements, a staff member should call the 24- hour State Central Registry Hotline 1-877-NJ-ABUSE (1-877-652-2873) to seek assistance in caring for the child.

For school-age child care program, no child shall be released from the program unsupervised except upon written instruction from the child’s parent(s).

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Policy on the Management of Communicable Diseases

If a child exhibits any of the following symptoms, the child should not attend the center. If such symptoms occur at the center, the child will be removed from the group, and parents will be called to take the child home. • Severe pain or discomfort• Acute diarrhea• Episodes of acute vomiting• Elevated oral temperature of 101.5 degrees Fahrenheit• Lethargy• Severe coughing• Yellow eyes or jaundiced skim• Red eyes with discharge• Infected, untreated skin patches• Difficult or rapid breathing• Skin rashes in conjunction with fever or behavior changes• Skin lesions that are weeping or bleeding• Mouth sores with drooling• Stiff neck

Once the child is symptom-free, or has a health care provider’s note stating that the child no longer poses a serious health risk to himself/herself or others, the child may return to the center unless contraindicated by local health department or Department of Health.

EXCLUDABLE COMMUNICABLE DISEASESA child or staff member who contracts an excludable communicable disease may not return to the center without a health care provider’s note stating that the child presents no risk to himself/herself or others.

Note: If a child has chicken pox, a note from the parent stating that all sores have dried and crusted is required.

If a child is exposed to any excludable disease at the center, parents will be notified in writing.

COMMUNICABLE DISEASE REPORTING GUIDELINESSome excludable communicable diseased must be reported to the health department by the center. The Department of Health’s Reporting Requirements for Communicable Diseases and Work-Related Conditions Quick Reference Guide, a complete list of reportable excludable communicable diseases, can be found at:

http://www.nj.gov/health/cd/documents/reportable_disease_magnet.pdf

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Positive Guidance & Discipline Policy

Participation in the Randolph YMCA Before/After School Care Program requires all students to meet certain standards of appropriate behavior. The YMCA adheres to a Positive Discipline Policy which respects the rights of the individual child, the group and the YMCA staff; while focusing on what the children SHOULD do, rather than what they should NOT do. Outlined below are various steps that may be taken if/when a student exhibits poor behavior. If a student demonstrates repeated inappropriate conduct, the Randolph YMCA has the right to suspend the student, or to dismiss him/her from the program. A meeting with the parent/guardian will be conducted prior to such dismissal, as is outlines in the YMCA Expulsion Policy.

The following describes the way inappropriate behavior may be handled within the Before/After School Care Program:

1. The Program Director is responsible for the behavior of the students at his/her school. Should a problem arise, the Program Director will be the staff person to handle it. His/her methods will be consistent with the age and developmental needs of the child, and should include patience, understanding and kindness.2. If a student is exhibiting poor behavior during an activity, the Program Director will try to re-direct the student to a new activity to change the focus of his/her behavior. For example, if a student is being disruptive, he/she may be asked to sit quietly at a different table, work on a puzzle, collage or drawing. A staff member may point out the consequences of the student’s behavior or actions, and remind him/her of acceptable ways to release feelings. 3. If the student does not respond to the above mentioned methods and continues to be disruptive, he/she will be asked to be seated on a special “thinking chair” or at a “special table.” The student will be able to see what is happening during the program, but will not be able to participate until he/she has regained his/her self-control. 4. As a last resort, and only if the student is so disruptive that the normal daily activities cannot proceed, the parent/guardian may be called and asked to come and remove the child from the program. At that point, the Program Director and parent/guardian will have a conference to exchange ideas on how to modify the child’s behavior. The student may be suspended from the program at this point. 5. If, after returning to school, the child continues to be disruptive and all methods of discipline have been exhausted, the child may be removed from the program permanently, as outlined in the YMCA Expulsion Policy.

Positive discipline is NOT:• Disciplining a child for failing to eat or sleep or for soiling themselves.• Hitting or shaking or any other form of corporal punishment.• Using abusive language, ridicule, harsh, humiliating or frightening treatment or any other form of

emotional punishment of children.• Withholding food, emotional responses, stimulation, or opportunities for rest or sleep.• Requiring a child to remain silent or inactive for an inappropriately long period of time. A child shall not be deprived of food or water, isolated, subjected to corporal punishment, or required to participate in abusive or excessive physical exercise as a means of punishment by staff.

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Expulsion Policy

Unfortunately, there are sometimes reasons we have to expel a child from our program either on a short term or permanent basis. We want you to know we will do everything possible to work with the family of the child(ren) in order to prevent this policy from being enforced.

The following are reasons we may have to expel or suspend a child from this center:

IMMEDIATE CAUSES FOR EXPULSION:• The child is at risk of causing serious injury to other children or himself/herself.• Parent threatens physical or intimidating actions toward staff members.• Parent exhibits verbal abuse to staff in front of enrolled children

PARENTAL ACTIONS FOR CHILD’S EXPULSION:• Failure to pay/habitual lateness in payments.• Failure to complete required forms including the child’s immunization records.• Habitual tardiness when picking up your child.• Verbal abuse to staff.• Other (explain)

CHILD’S ACTIONS FOR EXPULSION:• Failure of child to adjust after a reasonable amount of time.• Uncontrollable tantrums/angry outbursts.• Ongoing physical or verbal abuse to staff or other children.• Excessive biting.• Other (explain)

SCHEDULE OF EXPULSION:If after the remedial actions have not worked, the child’s parent/guardian will be advised verbally and in writing about the child’s or parent’s behavior warranting an expulsion. An expulsion action is meant to be a period of time so that the parent/guardian may work on the child’s behavior or to come to an agreement with the center. The parent/guardian will be informed regarding the length of the expulsion period and the expected behavioral changes required in order for the child or parent to return to the center. The parent/guardian will be given a specific expulsion date that allows the parent sufficient time to seek alternate child care (approximately one to two weeks’ notice depending on risk to other children’s welfare or safety). Failure of the child/parent to satisfy the terms of the plan may result in permanent expulsion from the center.

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Expulsion Policy Continued

A CHILD WILL NOT BE EXPELLED IF A PARENT/GUARDIAN:• Made a complaint to the Office of Licensing regarding a center’s alleged violations of the licensing

requirements. • Reported abuse or neglect occurring at the center. • Questioned the center regarding policies and procedures.• Without giving the parent sufficient time to make other child care arrangements.

PROACTIVE ACTIONS THAT CAN BE TAKEN IN ORDER TO PREVENT EXPULSION:• Try to redirect child from negative behavior.• Reassess classroom environment, appropriateness of activities, supervision.• Always use positive methods and language while disciplining children.• Praise appropriate behaviors.• Consistently apply consequences for rules.• Give the child verbal warnings.• Give the child time to regain control• Document the child’s disruptive behavior and maintain confidentiality.• Give the parent/guardian written copies of the disruptive behavior that might lead to expulsion.• Schedule a conference including the director, classroom staff, and parent/guardian to discuss how to

promote positive behaviors.• Give the parent literature of other resources regarding methods of improving behavior. • Recommend an evaluation by professional consultation on premises.• Recommend an evaluation by local school district study team.

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Technology, Communications & Social Media Policy

The Y recognizes the value of social media and other online communication tools for business purposes, such as connecting with members, staff, donors, and volunteers. In order to protect the Y, all employees and parents are expected to behave in a manner consistent with the Y’s values of caring, honesty, respect, and responsibility and to abide by this policy when using social media or other Online communication tools for work or personal purposes.

Many Y employees and parents maintain individual pages on social media sites and/or use other Online communication tools to connect and communicate for personal purposes. While the Y does not mean to interfere with anyone’s private life, the Y also realizes that publicly observable communications, actions, or words are not private. Individuals’ Online activities are accessible to the community at large; therefore, all Onli ne activities must be consistent with the YMCA’s mission and values.

Please be advised that the Randolph YMCA prohibits parents from posting photos or videos of any child in YMCA care, other than their own. We ask that you please respect other parents’ privacy and use discretion when using social media. Furthermore, YMCA staff are prohibited from communicating via social media with presently enrolled families outside of YMCA business (i.e. important announcements, upcoming events, and emergencies).

Students are prohibited from bringing any cell phones, iPod, or video games to the Y program. If a student possesses any of the above items, it must be kept in his/her backpack and turned off during program hours. The Randolph YMCA reserves the right to confiscate such items, including cell phones, should an attempt be made to either receive or send text, voice, audio, and picture or video messages during program hours. Use of the camera feature of any cell phone, digital camera, or other similar device is strictly forbidden.

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