dear algonquin lakes elementary school community,€¦ · headphones/ear buds –all supplies...

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Dear Algonquin Lakes Elementary School Community, Happy July! We wanted to reach out to our community as we have been busy preparing and planning for another great school year ahead and I am personally eager to continue a positive school culture and forge strong connections to ensure the best education possible for our students. Please join us in attending one of the 1:1 parent meetings this summer as well as some of the other informational presentations and sessions for our larger district community. Class Assignment Letters will be emailed home on August 3 rd as well as information regarding the first day of school. Back Pack Drop Off: August 9th 5PM – 8PM all ALES students and parents. Kindergarten Orientation: A special time for Kindergarten students and families to meet their teacher will be held on August 9 th . We will send home scheduled appointment notifications for our Kindergarten families on August 3 rd . First Day of School: August 16 th Open House: August 29th – K, 1st, and 2 nd grades – 6:30pm – 8:00pm and August 30 th – 3rd, 4th, and 5 th grades - 6:30pm – 8:00pm We are here to serve you during our summer office hours, which are 7AM to 3:30PM Monday through Friday throughout the summer. Thank you for your understanding as work is continuing on our facilities and grounds. My office door is open and I invite you to drop in anytime. Sincerely, Chris Columbaro

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Page 1: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

Dear Algonquin Lakes Elementary School Community,

Happy July! We wanted to reach out to our community as we have been busy preparing and planning for

another great school year ahead and I am personally eager to continue a positive school culture and forge

strong connections to ensure the best education possible for our students.

Please join us in attending one of the 1:1 parent meetings this summer as well as some of the other

informational presentations and sessions for our larger district community.

Class Assignment Letters will be emailed home on August 3rd as well as information regarding the first day of school.

Back Pack Drop Off: August 9th 5PM – 8PM all ALES students and parents.

Kindergarten Orientation: A special time for Kindergarten students and families to meet their teacher will be

held on August 9th. We will send home scheduled appointment notifications for our Kindergarten families on August 3rd.

First Day of School: August 16th

Open House: August 29th – K, 1st, and 2nd grades – 6:30pm – 8:00pm and August 30th – 3rd, 4th, and 5th grades - 6:30pm – 8:00pm

We are here to serve you during our summer office hours, which are 7AM to 3:30PM Monday through Friday

throughout the summer. Thank you for your understanding as work is continuing on our facilities and

grounds.

My office door is open and I invite you to drop in anytime.

Sincerely,

Chris Columbaro

Page 2: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

ALGONQUIN LAKES ELEM. SCHOOL SUPPLY LIST – 2016-2017

KINDERGARTEN

1 box of sandwich bags

10 pencils - #2 sharpened – yellow only

10 jumbo glue sticks

3 boxes of 24 count crayons

3 boxes of 8 count washable markers

1 pair of metal scissors

1 box of colored pencils

2 containers of baby wipes

2 sets of watercolors with brush

2 bottles of glue

2 large boxes of tissues

4 2-pocket vinyl folders (2 red, 1 yellow and 1 green)

1 pink gum eraser

2 spiral notebooks (1 blue and 1 red)

1 pack of highlighters (any color)

Gym shoes labeled with name (Kindergarten

Academy only)

Backpack without wheels labeled with name

Your child’s supplies will be placed in classroom

supply bins. For this reason please do not label

your child’s supplies.

FIRST GRADE – All supplies should be unwrapped

and labeled as noted.

1 box of colored pencils

1 box crayons – 48 count

1 package of thin markers

3 bottles of glue

3 containers of baby wipes

1 small school box (cigar sized) – labeled

9 jumbo glue sticks

1 watercolors w/ brush set

1 pack pencil-top erasers

72 yellow pencils - # 2 – sharpened

4 2-pocket folders w/name

2 2-pocket plastic folders with 3 hole prongs

2 large boxes of tissues

2 pairs of scissors, pointed, metal only

1 backpack without wheels, labeled w/name

Gym shoes to be left at school, labeled w/name

1 hand-held pencil sharpener w/ lid to catch shavings

1 pkg highlighters (any color)

1 box gallon size plastic zip bags

1 box sandwich zip bags

1 primary composition book with space at the top to

draw pictures (9 ¾ x 7 ½”)

3 - 70 pg wide ruled spiral notebooks

Headphones/ear buds

SECOND GRADE – All supplies should be

unwrapped and labeled as noted.

48 pencils - #2 –sharpened

2 boxes of crayons – 24 count

4 2-pocket folders

4 bottles glue – 8oz., white only

2 large boxes tissues

1 watercolors w/ brush set - primary colors

2 pink erasers

1 pair scissors – pointed, all metal blade

7 spiral notebooks, approx 8”x10”, wide-ruled

2 boxes of 8-count wide markers – regular colors

1 backpack or school bag – no wheels

2 containers of baby wipes

1 supply box (cigar sized)

1 box of freezer bags-(boys-gallon size and girls-

quart size)

Gym shoes to be left at school

6 glue sticks

1 yellow highlighter marker

Headphones/ear buds

THIRD GRADE

1 box 12-count colored pencils

48 pencils - #2 (sharpened)

2 boxes of crayons - #16 or more

1 bottle of glue – 8 oz.

2 large boxes of tissues

1 watercolors w/ brush set

5 2 - pocket folders with prongs

2 pink erasers

1 pair scissors – pointed, all metal

4 spiral notebooks – 8”x10”, wide – ruled (not

perforated)

1 CLEAR ruler – metric/inch

1 box of 8-count, wide markers – regular colors

1 old shirt for paint smock

1 pkg. looseleaf notebook paper, wide ruled

1 container of baby wipes

1 box freezer bags – boys gallon size or girls

sandwich size

Gym shoes to be left at school

10 LARGE glue sticks

Hand-held pencil sharpener

1 pkg. 3”x5” index cards

2 red pens

1 yellow highlighter marker

1 backpack without wheels

1 – 1½ inch hardcover binder with inside pockets

1 plastic 2-pocket folder without metal prongs

1 – 3 ring pencil pouch

Headphones/ear buds

Page 3: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

ALGONQUIN LAKES ELEM. SCHOOL SUPPLY LIST – 2016-2017

FOURTH GRADE – Please label all items

4 large glue sticks

4 2 pocket folders

2 black markers – fine point

1 hand held pencil sharpener

48 pencils - #2, sharpened

l box of 8-count markers

2 red ballpoint pens

2 gum erasers

2 boxes of tissues

1 box baby wipes

1 pair scissors – pointed, all metal

1 box crayons – 48 count minimum

2 bottles of glue – 8 oz

1 watercolors w/brush

1 pkg. looseleaf notebook paper

Gym shoes to be left at school

7 spiral notebooks (100 pages)

1 zippered pencil case - large

colored pencils – 24 count

2 highlighters (different colors)

1 box resealable plastic sandwich bags (last name A-

M)

1 box resealable large plastic storage bags (last name

N-Z)

1 backpack without wheels

1 – 2 inch hard cover binder with inside pockets

1 3-ring binder

1 spiral notebook with graphing paper

CLEAR PLASTIC protractor

NO SUPPLY BOXES, PLEASE!

Old Sock

Headphones/ear buds

ALTHOUGH NOT REQUIRED, IT WOULD BE

HELPFUL TO OWN AN APPROPRIATE

CALCULATOR AND DICTIONARY FOR ALL

STUDENTS, AND A THESAURUS FOR

INTERMEDIATE STUDENTS, TO BE KEPT AT

HOME.

FIFTH GRADE

1 box colored pencils

3 glue sticks

2 pink erasers

1 box of 8-count markers

1 box of 48-count crayons

24 pencils -#2

3 large boxes of tissues

scissors – pointed, all metal

6 2-pocket folders

1 pkg. notebook paper- large, regular-wide ruled

1 CLEAR ruler that measures inches and centimeters

5 ballpoint pens – red

4 spiral notebooks (100 pages each) wide ruled

1 manual, hand held pencil sharpener

Gym shoes to be left at school

1 box of baby wipes

2 highlighters (different colors)

1 100-count 3 x 5 white index cards – ruled

NO TRAPPER KEEPERS ALLOWED

1 backpack without wheels

6” protractor

1 box resealable plastic sandwich bags (last name A-

M)

1 box resealable large plastic storage bags (last name

N-Z)

1 flashdrive

2 1” binders with pockets

Headphones/ear buds

ALL GRADES – NO BACKPACKS WITH

WHEELS (DUE TO THE SIZE OF OUR

CUBBIES) OR TRAPPER KEEPERS -

NO MECHANICAL PENCILS

NOTE - There are no toys, games, radios, or

pencil sharpeners allowed unless specifically

requested by the teacher.

Page 4: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

ALGONQUIN LAKES ELEM. SCHOOL SUPPLY LIST – 2016-2017

MRS. HEER & MRS. WILSON

20 jumbo glue sticks

1 box 24-count crayons

1 box colored pencils

3 1-inch white binders with clear plastic cover

2 2-pocket folders with brads-solid colors only

8 large boxes of tissues

4 large containers baby wipes

1 set of extra clothes and shoes to be left at school

4 large boxes zip close sandwich size plastic bags

2 boxes of zip close gallon size plastic bags

Headphones/ear buds

Please do NOT send pencil boxes, pens,

mechanical or lead pencils, or pencil sharpeners

NOTE –There are no toys, games, radios, or

pencil sharpeners allowed unless specifically

requested by the teacher.

ALL GRADES – NO BACKPACKS WITH

WHEELS (DUE TO THE SIZE OF OUR

CUBBIES) OR TRAPPER KEEPERS

Page 5: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

DRAFT 2016-2017 CalendarEvent Day

Backpack Dropoff (5pm - 8pm) Tues 8 9

Kindergarten Orientation (Scheduled Appointments) Tues 8 9

First Day of School Tues 8 16

5th Grade Instrument Recruitment Thurs 8 25

Picture Day Fri 8 26

K, 1, and 2 Open House (6:30pm - 8pm) Mon 8 29

3, 4, and 5 Open House (6:30pm - 8pm) Tues 8 30

Early Release for Students (12:00pm) Fri 9 2

District Holiday - No School Mon 9 5

Parent-Teacher Organization Meeting (6:30) Tue 9 6

Early Release for Students (12:00pm) Fri 9 23

Fall Fest Sat 10 1

Parent-Teacher Organization Meeting (6:30) Tue 10 4

Fall Book Fair TBD TBD TBD

Early Release for Students (12:00pm) Fri 10 7

Picture Retakes Fri 10 7

District Holiday - No School Mon 10 10

Early Release for Students (12:00pm) Mon 10 31

Halloween Parties Mon 10 31

Parent-Teacher Organization Meeting (6:30) Tue 11 1

5th Grade Concert (7pm) Tues 11 1

Parent-Teacher Conference - No Student Attendance Mon 11 21

Parent-Teacher Conference - No Student Attendance Tues 11 22

I Made it Myself (2:15pm - 3:30pm) Tues 11 29

I Made it Myself (6pm - 7:30pm) Wed 11 30

Movie Night TBD

Parent-Teacher Organization Meeting (6:30) Tue 12 6

Early Release for Students (12:00pm) Fri 12 9

Winter Classroom Celebrations (1:15pm - 2:15pm) Thurs 12 15

Winter Break (Dec. 19 through Jan 2 ) - No School

Fall Break - District Closed Wed. - Fri (11/23 - 11/25)

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7/5/201612:22 PM

Page 6: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

DRAFT 2016-2017 CalendarEvent Day Date

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School Resumes Tues 1 3

Parent-Teacher Organization Meeting (6:30pm) Tue 1 3

January In-service - No Student Attendance Fri 1 13

District Holiday - No School Mon 1 16

Kindergarten Concert (6:30pm) Tues 2 7

1st Grade Concert (7:15) Tues 2 7

Parent-Teacher Organization Meeting (6:30) Tue 2 7

Valentine's Day Parties Tues 2 14

Early Release for Students (12:00pm) Fri 2 17

District Holiday - No School Mon 2 20

Early Release for Students (12:00pm) Thurs 3 2

Kane County Inservice - No School Fri 3 3

Parent-Teacher Organization Meeting (6:30) Tue 3 7

School Resumes Mon 4 3

Parent-Teacher Organization Meeting (6:30) Tue 4 4

2nd Grade Concert (6:30 pm) Tues 4 11

3rd Grade Concert (7:15) Tues 4 11

Early Release for Students (12:00pm) Thurs 4 13

District Holiday - No School Fri 4 14

If no emergency days taken - No School Mon 4 17

Academic Fair TBD TBD TBD

Early Release for Students (12:00pm) Fri 4 28

Movie Night TBD

Parent-Teacher Organization Meeting (6:30) Tue 5 2

5th Grade DARE Recognition TBD TBD TBD

5th Grade Band and Orchestra Concert (7:00 pm) Thurs 5 4

4th grade Concert (7:00 pm) Thurs 5 11

Early Release for Students (12:00pm) Fri 5 12

Field Day Thurs 5 25

Last Day of Student Attendance Thurs 5 25

Spring Break (Mar. 27 - Mar. 31) - No School

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7/5/201612:22 PM

Page 7: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

 i‐Ready Summer Challenge 

“Strive for 45”  

Community Unit School District #300 would like to challenge all students in grades K‐8 to participate in the i‐Ready Summer Challenge.   During the 2015‐16 school year, our district implemented a program called i‐Ready Diagnostic & Instruction.  This program assesses the students in the area of reading and math then provides an on‐line instructional path based on the unique academic needs of the students.  While you may already be familiar with the basic components of i‐Ready, the following link will give you a video overview of the program:  http://www.i‐ready.com/diagnostic‐training‐video.asp#5?version=11545. 

Summer is a great time for students to continue to develop their academic skills.  As a result, we are encouraging all students in grades K‐8 to engage in on‐line reading and math instruction in an effort to avoid “summer learning loss”.  It’s important that students participate in summer activities that will develop their cognitive skills. 

Here are the details:  

1. When: The i‐Ready Summer Challenge starts June 6th and ends August 7th. The goal for participating students will be to complete a weekly average of 45 minutes of on‐line instruction in reading and a weekly average of 45 minutes of on‐line instruction in math.     

2. Why: Research shows that when students are academically engaged during the summer, they retain their learning from the previous grade and return to school without the impact of “summer learning loss”.  

3. Where: Done from home online or where the student can access the Internet, the program provides a variety of math and reading activities for students to complete. Students must have access to a computer and Internet services.    

4. How: Parents / Guardians / Relatives will act as the learning coach to support their children in the utilization of i‐Ready.   

5. Registration: There is no registration required. To access the program’s materials, follow these 

steps: 

a. Go to https://login.i‐ready.com 

b. Username:  first initial last initial followed by ID# (i.e.  wd123456) 

c. Password:  student2015 

d. Click “Log In” 

 

*If you have any technical difficulty with the i‐Ready program, please email [email protected]

Page 8: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

 Reto del Verano de i‐Ready  

“Esforzarse por 45”  

Al Distrito 300 le gustaría invitar a todos los estudiantes de K‐8o grado a participar en el Reto del Verano de i‐Ready.  Durante el año escolar 2015‐16, nuestro distrito implementó el programa llamado “i‐Ready Diagnostic & Instruction”.  Este programa evalúa a los estudiantes en las áreas de lectura y matemáticas  y luego les provee una ruta de instrucción en línea basada en las necesidades únicas del estudiante.  Mientras que usted ya esta familiarizado con los componentes básicos de i‐Ready, el siguiente enlace les mostrará un video de información general del programa: http://www.i‐ready.com/diagnostic‐training‐video.asp#5?version=11545. 

El verano es un buen momento para que los estudiantes continúen desarrollando sus habilidades académicas.  Como resultado, estamos motivando a todos los estudiantes de K‐8º grado a que participen en la instrucción de matemáticas y lectura en línea con el motivo de evitar “perdida de aprendizaje durante el verano”.  Es importante que los estudiantes participen en actividades durante el verano que desarrollan sus habilidades cognitivas.   

Aquí están los detalles:  

1. Cuando: El Reto del Verano de i‐Ready empieza el 6 de junio y termina el 7 de agosto.  La meta para los estudiantes que participan es completar un promedio de 45 minutos semanales de instrucción en línea en lectura y un promedio de 45 minutos semanales de instrucción en línea en matemáticas.   

2. Por qué: Las investigaciones muestran que los estudiantes que participan académicamente durante el verano retienen su aprendizaje del previo grado y regresan a la escuela sin el efecto de “perdida de aprendizaje durante el verano”.  

 3. Dónde: Se puede hacer desde el hogar en línea o dónde el estudiante tenga acceso al internet; el programa 

proporciona una variedad de actividades en matemáticas y lectura para que los estudiantes lo completen.   

4. Cómo: Los Padres/ Tutores / Familiares actuarán como los entrenadores de aprendizaje de sus estudiantes en el uso de i‐Ready.    

5. Inscripciones: No se necesita inscribir.  Para tener acceso al material del programa, siga los siguientes 

pasos:  

a. Vaya a: //login.i‐ready.com 

b. Nombre de usuario: inicial de la primera letra del nombre y apellido seguido por el número de 

identificación de la escuela (i.e.  wd123456) 

c. Contraseña: student2015 

d. Haga clic en “Log In” 

*Si tiene usted algún problema técnico con el programa i‐Ready, por favor, envié un correo electrónico a 

[email protected].  

Page 9: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

Appointments available between 9:00AM — 4:00PM To make an appointment please call: 847-551-8371

Medical Card Accepted $25 Physicals*

Visit GEFCC.ORG for a complete list of insurances accepted. *Bring proof of income for sliding scale fee discount.

Sponsored by District 300 and Greater Elgin Family Care Center

BACK TO SCHOOL PHYSICALS

August 2nd Hampshire High School 1600 Big Timber Road Hampshire, IL 60140

August 3rd Jacobs High School 2601 Bunker Hill Drive Algonquin, IL 60102

August 4th Dundee Crown High School 1500 Kings Road Carpentersville, IL 60110

IMMUNIZATIONS WILL NOT BE PROVIDED AT THESE APPOINTMENTS!

Page 10: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

Citas disponibles durante las 9:00AM — 4:00PM Para hacer una cita llame al: 847-551-8371

*Traer comprobante de ingresos para su descuento.

Aceptamos la Tarjeta Médica Exámenes Físicos por $25

Visite GEFCC.ORG para más información sobre seguros médicos aceptados.

Una Colaboración del Distrito Escolar 300 y Greater Elgin Family Care Center

EXÁMENES FÍSICOS DE REGRESO A CLASES

2 de agosto Hampshire High School 1600 Big Timber Road Hampshire, IL 60140

3 de agosto Jacobs High School 2601 Bunker Hill Drive Algonquin, IL 60102

4 de agosto Dundee Crown High School 1500 Kings Road Carpentersville, IL 60110

NO SE PROVEERAN VACUNAS DURANTE ESTAS CITAS .

Page 11: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

Sponsored by District 300 and Greater Elgin Family Care Center

BACK TO SCHOOL PHYSICALS

APPOINTMENTS AVAILABLE AT :

Slade Health Center 901 Center Street

Elgin, IL 60120

FOR APPOINTMENTS CALL: 847-608-1344

■July 19th ■July 26th

■July 22nd ■July 29th

We offer a sliding fee discount, please bring proof of income to qualify. Visit GEFCC.ORG for a complete list of insurances accepted.

This summer you can get your children’s back to school physicals at one of

Greater Elgin Family Care Center’s locations near you!

Page 12: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

Una Colaboración del Distrito 300 y Greater Elgin Family Care Center

EXÁMENES FÍSICOS DE REGRESO A CLASES

CITAS DISPONIBLES EN :

Slade Health Center 901 Center Street

Elgin, IL 60120

PARA HACER UNA CITA LLAMA AL: 847-608-1344

■19 de julio ■26 de julio

■22 de julio ■29 de julio

Ofrecemos una escala de descuentos, favor de traer comprobante de ingresos. Visite GEFCC.ORG para más información sobre seguros médicos aceptados.

Este verano lleva a tus niños a uno de los centros de Greater Elgin Family Care

Center para recibir los exámenes físicos de regreso a clases.

Page 13: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

4/18/15

Rakow Center • 665 Barrington Ave. • Carpentersville, IL 60110 • (847) 428-7131 Randall Oaks Recreation Center • 500 N. Randall Rd. • West Dundee, IL 60118 • (847) 836-4260

Visit www.dtpd.org

Available 3 days, 4 days or 5 days each week (days need to be consistent each week) Fees: 5 days $91/month 4 days $77.76/month 3 days $62.10/month • 5% “paid in full” discount• Siblings receive a 10% discount All payments will be deducted electronically from your credit/debit account including the initial payment.

Registration begins Monday, May 2 at either the Rakow Center, 665 Barrington Ave, Carpentersville or the Randall Oaks Recreation

Center, 500 N. Randall Rd., West Dundee. Registration is

on a first-come, first-served basis. Space is limited. Please call Dawn with any questions at (847) 551-4327.

6:30 to Start of School

(Before School Child Care)

AMCircle ofFriends

School Year 2016-2017

Page 14: Dear Algonquin Lakes Elementary School Community,€¦ · Headphones/ear buds –All supplies should be unwrapped and labeled as noted. 48 pencils - #2 –sharpened 2 boxes of crayons

AM Circle of Friends 2016-2017

Program #589228

Registration Form

Participant’s Name Sex Birthday Sibling Section Registration Fee Monthly Fee

PLEASE CHECK DAYS YOUR CHILD NEEDS CARE (days need to be consistent each week) q M q TU q W q TH q F

CHECK THE GRADE LEVEL FOR YOUR CHILD (2016/2017 SCHOOL YEAR): q K q 1st q 2nd q 3rd q 4th

#4 RETURN FORM TO THE PARK DISTRICT

Mail In, Drop Off, or Fax:Rakow Center665 Barrington Ave., Carpentersville, IL 60110FAX: (847) 836-2380

Randall Oaks Recreation Center500 N. Randall Rd., West Dundee, IL 60118FAX: (847) 428-4880

ADA COMPLIANCE: Please notify staff at time of registration if your child requires special accessibility or accommodations for participation in these programs. q

Total Fees:

www.dtpd.org

Upon registration, the August payment plus a $40 nonrefundable registration fee per chid/per school year is required. Your next payment will be due September 1. All payments will be deducted electronically from your credit/debit accounts.

Section Fees* AL Algonquin Lakes 5 Days $91/month LI Liberty 4 Days $77.76/month 3 Days $62.10/month

* 5% paid in full discount

* Siblings receive a 10% discount.

PAYMENT: Complete the attached Automatic Credit/Debit Authorization Form.

Family’s Last Name: Home Phone #:

________________________________________________________________ _________________________________________________________________Address: Cell Phone #:

________________________________________________________________ _________________________________________________________________City, Zip Name of Father Father’s Work #:

________________________________________________________________ _________________________________________________________________E-Mail Address: Name of Mother Mother’s Work #:

________________________________________________________________ _________________________________________________________________

Emergency Contact Name: Emergency Contact Phone #:

________________________________________________________________ _________________________________________________________________

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WAIVER MUST BE SIGNED TO REGISTER

1. Does your child have any allergies and/or special dictionary restrictions? q Yes q No

If yes: ___________________________________________________________________________________________________________

________________________________________________________________________________________________________________

2. Who is authorized to pick up your child?

Name: _________________________________ Relation: _________________________ Contact #: _____________________________

Name: _________________________________ Relation: _________________________ Contact #: _____________________________

Name: _________________________________ Relation: _________________________ Contact #: _____________________________

3. Anyone legally restricted from picking up your child? q Yes q No

If so who: _______________________________________________________________________________________________________

________________________________________________________________________________________________________________

Date Signature of Parent or Guardian

IMPORTANT INFORMATION The Dundee Township Park District is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. The Dundee Township Park District continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However, participants and parents/guardians of minors registering for this program must recognize that there is an inherent risk of injury when choosing to participate in recreation activities.

You are solely responsible for determining if you or your minor child/ward is physically fit and/or adequately skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity.

WARNING OF RISK Swimming is a sport which challenges and engages the physical, mental and emotional resources of each participant. However, despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury, including but not limited to drowning, head/brain injury, and cervical spine injury. Understandably, not all hazards and dangers can be foreseen. The very nature of swimming is hazardous and risky, including but not limited to fatigue and overexertion, poor swimming skills, failing to avoid dangerous areas, horseplay, diving or cannon-balling into shallow water and striking the bottom or side of the pool, poor supervision or instruction, lack of conditioning, becoming disoriented, striking other swimmers, defective or inadequate equipment, striking one’s head on the bottom when using a diving block, slipping or falling on the deck or within the locker facility, chemical exposure and all other circumstance inherent to the sport of swimming. In this regard, it must be recognized that it is impossible for the Dundee Township Park District to guarantee absolute safety.

WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK Please read this form carefully and be aware that in signing up and participating in the below identified programs/activities, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with said programs/activities (including transportation services and vehicle operations, when provided).

I recognize and acknowledge that there are certain risks of physical injury to participants in these programs/activities, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in these programs/activities against the Dundee Township Park District including its officials, agents, volunteers and employees.

I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.

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