Fletcher Maynard Community School & Neighborhood Council2. Table of contents and drop in office hours schedule 3. Letter to parents 4. Registration & payment policy 5. Scholarships,

FMCS Fall 2011 City of Cambridge Department of Human Service Programs-Community Schools Division (617) 349-6295

Fletcher Maynard

Community School & Neighborhood Council

Fall 2011 Brochure

Session dates: Monday, September 19th –Thursday, December 22nd

(Pre-session supervised activities week: Monday 9/12- Friday 9/16)

Yuliya Goncharov, Community School Director 617.349.6295, [email protected]

www.cambridgema.gov/DHSP2/fletcher.cfm

Department of Human Service Programs - Community Schools Division - City of Cambridge

FMCS Fall 2011 City of Cambridge Department of Human Service Programs-Community Schools Division (617) 349-6295 IMPORTANT DATES

Date Activity Time/Location

Friday 8/26/11 Back to School Bash

Fall 2011 Registration opens

5:30-7:30pm- Green Rose Heritage Park (rain location:

FMA gym)

Monday 9/12/11- Friday 9/16/11

Pre-session supervised activities week

(advanced registration required)

3:45-5:30pm- FMCS

Monday 9/19/11 First day Fall 2011 Enrichment

Classes 3:45-5:30pm- FMCS

Tuesday 9/20/11

FMA Early Release Day field trip to the Museum of Science

Imax movie: Amazing Journeys

12:00- 5:30pm-

Museum of Science and FMCS

Tuesday 9/27/11 Neighborhood Council Meeting 6:00-7:30pm- FMA 1st floor

conference room

Saturday 11/5/11 Adult Trip: Grown-Ups Day Out

Holiday Shopping trip to Wrentham Outlets

Bus Departs from the FMA at 8:30am & returns by5:00pm

Wednesday

11/23-11/25

Thanksgiving Break- No FMCS Classes

Tuesday 11/15/11 Neighborhood Council Meeting 6:00-7:30pm- FMA 1st floor

conference room

Thursday 12/8/11 Family Evening Program: Teddy Bear Making Workshop 5:30-7:30pm- FMA Cafeteria

Wednesday 12/21/11

Fall 2011 Family Showcase Celebration

5:30-7:00- FMA Cafeteria

Thursday 12/22/11 Last day of Fall 2011 Classes

FMCS Fall 2011 City of Cambridge Department of Human Service Programs-Community Schools Division (617) 349-6295 FLETCHER MAYNARD COMMUNITY SCHOOL& NEIGHBORHOOD COUNCIL

Administrative Staff: Enrichment Core Staff:

Yuliya Goncharov, Community School Director Alanna Barton

Ellen Thompson, Program Manager Jessica Balkishun

Eileen Keegan Bongiorno, Division Head, Community Schools Carolann Nowlan

Remy Lawler

Elizabeth Snell

Table of Contents:

1. Important dates 2. Table of contents and drop in office hours schedule 3. Letter to parents 4. Registration & payment policy 5. Scholarships, refunds, pick up, late fee and homework policies 6. Early release days, holidays, snow days and DHSP Inclusion statement 7. Jr. Kindergarten and Kindergarten Enrichment Class choices 8. 1st& 2nd grade Enrichment Class choices 9. 3rd& 4th grade Enrichment Class choices Registration Checklist & Piano lessons information 10. Piano lessons, Senior programs and Family activities 11. Adult and Family programs registration forms (Please detach and return to the FMCS) 12. Enrichment Registration and Class Selection Sheet (Please detach and return to the FMCS)

Community School

Office Hours:

Monday Tuesday Wednesday Thursday Friday

Morning 10:00 am- 12:30 pm

10:00 am- 12:30 pm

10:00 am- 12:30 pm

Afternoon

3:30 pm- 5:30 pm

3:30 pm-

5:30 pm 3:30 pm- 5:30 pm


A warm welcome to all new and returning families!

Dear Parents, Guardians and Community Members,

The days are getting shorter and the leaves will soon change colors. It’s time to refill backpacks with school supplies and get ready for a new school year. This year we will offer exciting new enrichment classes and a brand new Space Travel pre-session week, beginning Monday, September 12th- Friday, September 16th. Regular enrichment classes will begin on Monday, September 19th.

Very soon the holiday season will be upon us, and wouldn’t it be nice to get the shopping done early and on a budget? Wouldn’t it be fun to leave the kids with a friend for a day of stress-free shopping? Join us on Saturday, November 5th for a “Grown-Ups Day Out” shopping at the Wrentham Outlet Mall! A school bus will leave the Fletcher Maynard Academy at 8:30am and return approximately by 5:00pm, transportation fee $10.

Back by popular demand is our Family Night Teddy Bear Making Workshop! Date is still to be announced, so stay tuned!

I hope that you take a few minutes to browse our selection of activities. This brochure contains important program policies as well as class descriptions and registration information. We try to offer something for everyone, so if you have any ideas for a program or class, come by and let us know at one of our bi-monthly Neighborhood Council meetings or send an email to [email protected].

We welcome new members to the Fletcher Maynard Neighborhood Council, and if you are interested in joining don’t hesitate to ask more about our group! The Fletcher Maynard Neighborhood Council meets bi-monthly to discuss and shape the future of the Community School program. We are eager to hear your ideas and suggestions and welcome all community members to join us for our next meeting on Tuesday, September 27th at 6:00pm in the FMA first floor conference room. I look forward to hearing from you! Please don’t hesitate to contact me with any questions or concerns directly at (617) 349-6295 or [email protected]. Sincerely, Yuliya Goncharov Community School Director Fletcher Maynard Community School & Neighborhood Council

mailto:[email protected]


General Program Information and Policies

REGISTRATION PROCEDURES Formal registration begins Friday, August 26th and concludes Thursday, September 15th. There is a new $20 registration fee per academic year to cover administrative costs. You may register in the Community School office, room 018 between 10:00am–12:30pm or 1:30pm – 5:30pm, Monday- Friday. Registrations are accepted on a first-come, first-served basis. After the registration period ends, registration is ongoing if space permits. The registration form included in this brochure must be completed and brought to the Community School Office along with additional forms listed below.

For all applicants the following is required:

o Community School registration form

o Community School Enrichment Class Selection form

o DHSP application for enrollment

o IEP release and consent form

o Emergency card (including Primary Care Physician and Insurance information)

o One-time Registration Fee $20 (to help cover administrative costs)

o Payment is due at registration (minimum $75 deposit)

PAYMENT POLICY -To attend our enrichment program for the full Monday-Friday afterschool session there is a fee of $320 total which covers the 4 month session and includes the registration fee. -If you wish to pay in 4 installments of $75 each, please note that these payments will be due on the 1st day of each month. This is a payment plan option and is not required, if you choose this option, a $75 deposit minimum is required at time of registration. Excessive late or missed payments will result in suspension of services. - Enrollment in a single class costs $40 per session/per class. (There may be additional fees for specialty classes.) - Any outstanding balances due to any Department of Human Service Program your child will delay registration until all payments are up to date.

We accept Checks and Money Orders, no cash!

Please make your checks payable to: Fletcher Maynard Community School

-There will be a $25.00 additional fee for checks returned due to insufficient funds.

FMCS Fall 2011 City of Cambridge Department of Human Service Programs-Community Schools Division (617) 349-6295 If you have any questions, please get in touch with us at (617) 349-6295 or [email protected] SCHOLARSHIPS A limited number of need-based partial scholarships are available to income qualifying families. Please request a financial aid application directly from Yuliya at the Community School office. Proof of income will be required with requests for scholarships. (W-2 forms or copies of 4 most recent paystubs along with any other benefits received) The deadline to apply for a Fall 2011 scholarship will be Friday 9/16/11.

Donations of any amount to our scholarship fund directly help families in need. We welcome your contribution to assist us in meeting the needs of those dealing with financial hardships. Please consider making a donation to the Fletcher Maynard Community School for this purpose. REFUND AND CANCELATION POLICY Partial refunds will be given if a child is no longer able to participate due to medical reasons, with supporting documentation from your child’s physician. PICK UP POLICY All children must be promptly picked up at the end of class. Please sign your child out when you arrive to verify that they have been picked up. For the safety of your child please indicate on your registration form who will be picking up your child.

LATE FEE POLICY A $1 per minute late fee will be assessed for pickups after the program ends. Time will be measured by the classroom clock. We require late fees to be paid within 48 hours. Excessive late pick-up may result in suspension of services.

Fletcher Maynard Community School will not be responsible for children arriving to our

program before 3:45pm (M, T, Th, F)

HOMEWORK CLUB POLICY

We provide a 45 minute-1 hour period for homework assignments every day where students are provided with a quiet independent working environment and materials to start their homework. Adults are available to answer questions and assist when needed, however we can’t provide individual tutoring at this time. At the end of the period, and a short transition, enrichment classes will begin promptly. If you feel your child will need more time to complete their homework we now offer an Extended Homework Club option, with advance enrollment required.

mailto:[email protected]


EARLY RELEASE DAYS: FMA Students are released at 2:00pm each Wednesday.

FMCS will run an early release day activity on Tuesday, September 20th from 12:00pm- 5:30pm. The activity is a trip to the Museum of Science’s IMAX theatre and requires advance registration at an additional cost.

Space Travel Activity Week: We will be offering a week of supervised activities based on the theme of space travel, beginning Monday, September 12th through Friday, September 16th for an additional fee of $10 per day, per child. Space Travel Week participants will enjoy activities such as gym games (space invaders), art projects (egghead alien creatures and origami rockets), science (Lego space stations and planet studies), story time and much more! Please note: if you would like to register for our Space Travel Activity Week, the registration deadline will be Wednesday, September 7th.

HOLIDAYS AND SNOW DAYS Classes are not held on snow days, school holidays or any other day there is no school for the Cambridge Public Schools. Special activities or trips will be planned for February and April vacation weeks at an additional cost.

The Department of Human Service Programs Inclusion Statement is as follows:

"The Department of Human Service Programs welcomes individuals with disabilities in all of its Out of School Time Programs. DHSP will provide reasonable accommodations to individuals with disabilities who meet the basic eligibility requirements of the OST programs or who with the provision of reasonable accommodations will be able to meet the basic eligibility requirements, to facilitate equal participation for those individuals in existing OST Programs".


Youth Enrichment Classes

Mon

day

Monday at 4:00-4:45 Monday at 4:45-5:30

JK/K Homework Club A quiet environment for independent homework focus. Staff

will be available to answer questions and assist as needed. Instructor: Betty

Project Joy JK-1st grade Come play collaborative games with your friends. The best part is

it’s us against you. Do you think you have what it takes to beat the CS staff? Instructor: Alanna

1st& 2nd grade Homework Club A quiet environment for independent homework focus. Staff

will be available to answer questions and assist as needed. Instructor: Alanna

JK/K Pumpkins, Pumpkins Everywhere! NEW CLASS! Pumpkins will be the theme for this project based learning class.

We will count, weigh, draw, sing, dance and eat our way through! Instructor: Betty

3rd -6th Grade Homework Club A quiet environment for independent homework focus. Staff

will be available to answer questions and assist as needed. Instructor: Jessica

1st& 2nd grade Computer Literacy & Skills This class is a special opportunity to explore a variety of

educational computer based activities. Instructor: Jessica

JK-2nd grade Yoga Yoga postures and movements develop flexibility, gross motor

ability and calm the mind. Ommmmm… Instructor: Remy

2-6th grade Yoga Yoga postures and movements develop flexibility, gross motor

ability and calm the mind. Ommmmm… Instructor: Remy

3+ Inventor’s Lab Gadgets and gizmos a plenty! We will invent and build new and

exciting creations from recycled materials. Instructor: TBA

Extended Homework Time: All grades This is an opportunity for students who may need a little extra

time to complete homework assignments. Instructor: Carolann

Tues

day

Tuesday at 4:00-4:45 Tuesday at 4:45-5:30



JK/K Fun with Phonics NEW CLASS! Fun activities and games build literacy skills with a focus on fun!

We will be practicing and mastering important readiness and reading skills.

Instructor: Betty


will be available to answer questions and assist as needed. Instructor: TBA

JK-2 Art Class: Collage Me Crazy! Colorful and multi-textured materials will be used to create

original artwork. Instructor: Remy


will be available to answer questions and assist as needed. Instructor: Carolann

1st& 2nd grade Math Games Math is all around us! Playing with money, fractions and simple logic problems will show you how much fun math

can be. Instructor: TBA

JK- 2nd Grade Around the World We will explore cultures from all over the globe through art,

song and foods in this fun and exciting class! Instructor: Remy



FMCS Fall 2011 City of Cambridge Department of Human Service Programs-Community Schools Division (617) 349-6295 (4:45-5:45pm) 3rd -5th Grade Discovery Museums Science NEW CLASS!

Have you ever used a banana to hammer in a nail? Made your hair stand up on end with the power of electricity? Created a mini laser light show? Lifted a person three times your size without lifting a finger? Join us for hands-on fun as we explore the worlds of Chemistry, Electromagnetism, Flight, Light, Sound, Microscopes, Bubbles and more. 12 different science adventures await you!

The Discovery Museums in Acton has 30 years of experience providing school age, hands-on, physical science programs that elicit curiosity and encourage observation, questioning, testing and sharing ideas. Scholarships available and generously supported by Novartis, this program offers afternoons of fun, quality science exploration at an affordable price!

Instructor: The Discovery Museums, assisted by FMA staff

1st& 2nd grade Italian Cooking 1.5 hour class: 4:00-5:30pm NEW CLASS! Discover the joy of cooking in a fun and cooperative environment! A variety of classic Italian recipes will be prepared with an

emphasis on safe food preparation techniques, teamwork and tasting! Instructor:Alanna

3rd -6th Grade Harvard STAGE & Drama Games Volunteers from Harvard lead an acting and self-empowerment workshop. Students will learn improvisational acting, write plays

and even visit Harvard University’s Campus! 1.5 hour class: 4:00-5:30pm

Wed

nesd

ay

Wednesday 2:30-3:30 Wednesday 3:30-4:30 Wednesday 4:30-5:30

Science Club for Girls Grades JK-8th MIT Science Club for Girls

Explore science topics with your peers! Instructor: SCFG Staff -3rd Floor

(9 weeks only)

JK/K Homework Club A quiet environment for independent

homework focus. Staff will be available to answer questions and

assist as needed. Instructor: Remy

JK/K Science, SPLAT! Slimey, strange and fascinating

experiments will be the focus of this fun new class open to boys and girls.

Instructor: Remy

JK- 2nd Grades Fun with Play Dough NEW CLASS!

We will learn to make our own play dough and then use it to create fun sculptures

using clay tools and our hands!

Instructor: Remy

1st& 2nd grade Homework Club A quiet environment for independent


assist as needed. Instructor: Alanna

JK-2nd grade Recycled Art NEW CLASS! With us it’s easy being green (and fun too)! We will use found objects and

recycled materials to make exciting art sculptures!

Instructor: Rachel 1st-6th Grade Lego Land

Have fun with your friends. Build a city, a building or even a jungle using Legos.

Instructor: Jessica

3rd -6th Grade Homework Club A quiet environment for independent


assist as needed. Instructor: Carolann

1st -6th Grade Kickball Come play a favorite sport with your friends. We will walk over to nearby Green Rose Heritage park, weather

permitting, for some fun while the good weather lasts!

Instructor: Alanna (outdoors, weather permitting)

3rd -6th Grade Latin American Cooking NEW CLASS!

Discover the joy of cooking in a fun and cooperative environment! A variety of exciting Latin American cuisine will be

prepared with an emphasis on safe food preparation techniques, teamwork and

tasting. Instructor: Alanna

NEW CLASS! JK-2nd Grade Painting & Drawing

Do you love to doodle? So do we! We will use a variety of drawing and

painting materials & techniques to create inspiring artwork.

Instructor: Rachel

3rd -6th Grade Clay Explorations Clay is a fantastic material that can be

molded, shaped cut, slumped and slipped into anything you want! Sculpture and simple pottery will be the focus of this

introductory class. Instructor: Jessica

1st& 2nd Clay Explorations Clay is a fantastic material that can be

molded, shaped cut, slumped and slipped into anything you want!

Sculpture and simple pottery will be the focus of this introductory class.

Instructor: Jessica

Extended Homework Time: All grades

This is an opportunity for students who may need a little extra time to complete

homework assignments. Instructor: Carolann Room 005

FMCS Fall 2011 City of Cambridge Department of Human Service Programs-Community Schools Division (617) 349-6295 Th

ursd

ay

Thursday 4:00-4:45 Thursday 4:45-5:30



JK/K Math Games Math is all around us! Playing with money, fractions and simple

logic problems will show you how much fun math can be. Instructor: Betty


will be available to answer questions and assist as needed. Instructor: Carolann

JK-2nd Grade Creative Movement and Music Let’s explore all the things our bodies can do, by dancing and

playing games that involve movement. Instructor: TBA


will be available to answer questions and assist as needed. Instructor: Jessica

1st& 2nd grade Animal Art NEW CLASS! Animals are fascinating and inspiring! We will learn about

animals and create art projects using various materials. Join us on this artistic adventure! Instructor: Alanna

JK/K Animal Art NEW CLASS! Animals are fascinating and inspiring! We will learn about

animals and create art projects using various materials. Join us on this artistic adventure! Instuctor: Alanna

3rd -6th Grade 4 Square NEW CLASS! Do you have what it takes to get into the 4th square? This simple

playground game requires patience, problem solving, and cooperation. Instructor: TBA

1st & 2nd Grade Reading Adventures In this class, We will play games based on phonics and literacy development. We’ll dance and sing songs. Join us for a whole

lot of fun! Instructor: TBA

3rd -6th Grade Printmaking A variety of printmaking techniques will be explored with an

emphasis on creative expression and fun! Instructor: Jessica



Frid

ay

Friday 4:00-4:45 Friday 4:45-5:30

JK/K Grade Let’s Find Out! (Scholastic) NEW CLASS! Every week we will open our Scholastic magazines and explore

exciting new topics through literacy, arts, and hands on activities!

Instructor: Betty

JK-2nd Grade Beading and Weaving Weaving takes patience and problem solving & beads are a fun and colorful material for the development of fine motor skills.

We’ll learn, have fun and create something to take home! Instructor: Remy

JK/K Grade Just Baking NEW CLASS! Discover the joy of cooking in a fun and cooperative

environment! A variety of exciting Latin American cuisine will be prepared with an emphasis on safe food preparation

techniques, teamwork and tasting. Instructor: Jessica

JK-1st Trucks, Trains & Planes Why does a plane fly? Why does a race car zoom? Come and find out! A classic theme comes alive through hands-on activities and

games. Instructor: Betty

Group Games JK-2nd NEW CLASS! As the weather warms up, it’s important to stay active. In this class students will have the opportunity to play group games in

the gym or outdoors for a variety of recreational activities. Instructor: Alanna (Outside, weather permitting)

1st -2nd Grade Step Dance NEW CLASS! (To be announced….)

1st & 2nd Wacky Science Slimey, strange and fascinating experiments will be the focus of

this fun class open to boys and girls. Instructor: Remy

Project Joy 2nd-6th grade Come play collaborative games with your friends. The best part is

it’s us against you. Do you think you have what it takes to beat the CS staff? Instructor: Alanna

1st-6th Fall Crafts Fall is a fun and colorful season, celebrate this magical time of year with a variety of arts and crafts with your

friends! Instructor: Carolann

3rd -6th Grade Super Salads NEW CLASS! Chicken salad, potato salad, fruit salad… the list is endless! Join

us for a unique twist on salad preparations and nutritious recipes.

Instructor: Jessica

FMCS Fall 2011 City of Cambridge Department of Human Service Programs-Community Schools Division (617) 349-6295 3rd -6th Grade Step Dance NEW CLASS!

(to be announced……)

1/2 hr. Piano or Violin Lessons Ages 5-Adult

Instructor: Melanie Maz

Lessons will be held between 2:30pm- 5:30 pm on Wednesdays for 12 weeks for an additional charge of $180. Priority time selection will be given to returning students. To register, please indicate your interest on the attached Enrichment Class Selection form. Classes will begin Wednesday, September 28th. The registration deadline for piano lessons is Friday, September 23rd.

Family Activities:

Halloween Party: Monday, October, 31st 4:00-6:00pm in the FMA Gym

We are teaming up again with the Fletcher Maynard Academy for our annual Halloween Party! Join us for snacks, games, dancing and a spooky good time! - FREE

Family Fun Teddy Bear Making Workshop: This holiday make some time to spend with your family and create something truly special. Each child will have the opportunity to choose, stuff and dress their very own bear to take home! We will provide all the materials to make each bear uniquely yours. Parents are strongly encouraged to help their children in the creation of their teddy bear. The cost of this activity is $16.00 per bear Date: Thursday, December 8th, @ 5:30-7:30 in the FMA Cafeteria

Adult Activities:

Grown-Ups Day Out Holiday Shopping trip to Wrentham Outlets:

Join your friends and neighbors and kick-start your holiday shopping. Just think: you could get it all done in one fun and relaxing trip!

Saturday, November 5th School bus departs from the FMA at 8:30am and departs Wrentham at 4:00pm The cost of this activity is $10.00 per person


Senior Activities:

With support from Tufts Health Plan Foundation and the Cambridge Community Foundation we are continuing to offer monthly craft workshops for the seniors of the New Age Retirement home on Norfolk St. This session we will be working with Fimo beads and designing necklaces, creating cut/tie fleece pillows, folding origami holiday cards and more! Join us for fun crafts and a healthy afternoon snack. Dates and times are TBD; please contact Yuliya Goncharov, Community School director at (617)349-6295 for more information.

The Fletcher Maynard Neighborhood Council meets bi-monthly to discuss issues affecting the Area 4 neighborhood. The Fletcher Maynard Community School’s goal is to offer programs that fulfill the needs of our neighborhood by providing affordable activities for children, adults, seniors, and families, and the Neighborhood Council serves as an advisory group to the Community School director. We welcome all Area 4 residents, local business owners and families to join and give your support in determining neighborhood needs, suggesting future programs and recognizing community issues and concerns.

We hope you join us Tuesday, September 27th and Tuesday, November 15th 6:00-7:30pm in the Fletcher Maynard Academy 1st floor conference room to discuss how we can work together to better serve our community. The topics for these meetings include program development, increasing parent participation and pertinent community issues. Tea and dessert will be served, childcare will be provided by our afterschool staff.

FMCS Fall 2011 City of Cambridge Department of Human Service Programs-Community Schools Division (617) 349-6295 JK-6th Enrichment Class Selection Form

Student’s Name: __________________________________________ Grade:______ Please write your class selections in the appropriate day and time slot, detach and return to the FMCS

Monday (4:00-4:45)

Monday (4:45-5:30)

Tuesday (4:00-4:45)

Tuesday (4:45-5:30)

Wednesday (2:30-3:30)



Thursday (4:00-4:45)

Thursday (4:45-5:30

Friday (4:00-4:45)

Friday (4:45-5:30)

Select your choices by circling or checking below:

1) Full Day Monday-Friday- $300.00 for the duration of the Fall session (excludes music lessons)

___ (Check here to select the following payment option: 4 payments of $75, due on the first day of each month)

2) Individual Classes: $40.00 x _____ = $______.00

($40.00 x (# classes) = (total session cost)

3) Space Travel Week: (add $10 per day) ___Monday, 9/12 ___Tuesday, 9/13 ___Wednesday, 9/14 ___Thursday, 9/15 ___Friday, 9/16

4) Piano Lessons : (add $180.00) Wednesdays: 2:00 - 2:30 - 3:00 - 3:30 - 4:00 - 4:30 - 5:00

(Please choose your time preference(s). Priority will be given to returning students.)

Application Checklist:

o Community School registration form

o Community School Enrichment Class Selection form

o DHSP application for enrollment

o IEP release and consent form

o Emergency card

o One-time Registration Fee $20 (per school year)

Registration fee: Add $20.00

Total Amount Due: $_________.00 Office Use Only, Do not write below: Payments received: Date:_____ Check #_____ Amount:________

Date:_____ Check #_____ Amount:________




o Payment (minimum $75 deposit)

We accept Checks and Money Orders, no cash! Please make your checks out to: Fletcher-Maynard Community School There will be a $25.00 additional fee for checks returned due to insufficient funds.

FMCS Fall 2011 City of Cambridge Department of Human Service Programs-Community Schools Division (617) 349-6295 Fletcher Maynard Community School & Neighborhood Council

JK-6th Enrichment Classes Registration Form – Fall 2011 STUDENT INFORMATION

(Please use a separate form for each child.)

Name: _______________________________ Date of Birth: _______Age: ______ Male/ Female (circle one) Address: _________________________________________________Phone: ________________________ School Name: ______________________Teacher: _________________ Grade: ______Room Number: ____ Ethnicity: Afro American ___Caucasian ___ Hispanic __ Asian ___Haitian ___ Other__ Please list any allergies or medical conditions_____________________________________________________

Does your child have an Epi-pen for anaphylactic shock? (circle one) YES NO

Does your child have any dietary restrictions? (circle one)YES NO (if yes, please describe:______________________________________________________________________

PARENT/GUARDIAN INFORMATION Parent/Guardian (1) Name: ___________________________________________ Home Address: ____________________________________________________ Home Phone: __________________________Work or Cell Phone: ___________________________ Email Address: _____________________________________________________ Parent/Guardian (1) Name: ___________________________________________ Home Address: ____________________________________________________ Home Phone: ___________________________Work or Cell Phone: ___________________________ Email Address: _____________________________________________________

EMERGENCY CONTACT (In case we can’t reach a parent/guardian)

Emergency Contact’s Name: ______________________________________Relationship: ________________ Home Phone: ___________________________Work or Cell Phone: ____________________________

RELEASE AND SIGNATURE: Please initial, sign & date at the bottom ____ I give my child permission to walk home. ____My child will be picked up by 5:30 by:

1. (name/relationship)_________________________ (phone)_________________

2. (name/relationship)_________________________ (phone)_________________ *____I give permission for my child to participate in Fletcher Maynard Community School Enrichment Classes and all program activities including outings. If my child should require medical attention, I give permission for such treatment, including transportation to the nearest hospital in an emergency. ___ I give permission to the Fletcher Maynard Community School to take pictures and use photographic and video reproductions of my child for publicity purposes.

*Parent/Guardian Signature: _________________________________ Date: _________

Documents

Fletcher Maynard Community School & Neighborhood Council2. Table of contents and drop in office hours schedule 3. Letter to parents 4. Registration & payment policy 5. Scholarships,