4505 236th Avenue NE Redmond, WA 98053 Phone

4505 236th Avenue NE Redmond, WA 98053 Phone: (425) 284-1028

4505 236th Ave NE Redmond, WA 98053

Dear new TAS Families,

We are so honored and excited that you’ve decided to enroll your child at TAS. I’m very confident you’ve

made a great decision!

To give you an idea of why we do the things we do, let me start by including our philosophy:

Timberlake After School will always strive to provide the best possible environment for each and

every child in our care. Our desire is to encourage growth in all areas of development, while

allowing kids the chance to discover their own personal niche wherever that may be, growing

their self-esteem, self-worth and confidence along the way. We understand that the elementary

school years are a wonderful opportunity to begin to bridge dependence with approaching

independence as we strive to provide each child with the foundation they need to be successful

in middle school, high school, and beyond.

We understand that the kids have just spent several hours at school and may be feeling a little worn

down. That’s why we want to focus on walking alongside each child as they seek their own personal

talents and skills in a relaxed but fun environment. We’ll always encourage each child to try something

new and support them through their victories and struggles.

Because your child cannot begin attending TAS until all forms have been turned in, please complete and

return the enclosed forms before your child’s intended first day.

If at any time you have questions, concerns, or comments my door is always open. You can contact me

directly at (425) 284-1028 or via email at [email protected].

Again, we’re so excited to have you and your child on board with us!

Sincerely,

Julia Erman Director Timberlake After School


Program Offerings

Inside, kids may choose to:

Get comfy in our cozy library and homework area to read a book

Allow their imagination to lead as they design and create in the Construction Zone or accept the

weekly “Engineer’s Challenge”

Create either the daily craft or delve into the many art supplies to create a one of a kind

masterpiece in the Art Center

Challenge a friend to a board or card game

Dance or play on the Kinect

Race through our indoor inflatable obstacle course

Explore and discover new interests and skills like cooking, science, and nature encounters

through weekly clubs

Outside, kids may choose to:

Join a staff-led game that will focus on teamwork and cooperation

Explore less traditional games like human bowling or even create and teach their own game

Strengthen muscles and enhance agility while climbing the play structure on our playground

Breathe in the fresh air while relaxing with a book or creating outside art


Registration Procedures

We’re so glad you’re considering Timberlake After School (TAS)! To enroll your child(ren) please read

and complete all paperwork and return it to the TAS office. The paperwork may be picked up at TAS or

printed off our website: www.timberlakechurch.com/afterschool. There are two fees associated with

registration:

1. The registration fee: $100 or $150 per family (non-refundable)

2. Activity fee: $60 per child (annual; refundable)

a. The field trip fee is not due with registration but will be added to your first monthly

invoice

Payments can be made via check, credit card (Visa, MasterCard, or Discover), or Electronic Funds

Transfer. At the time of registration, the following will be due:

1. The registration fee (non-refundable)

2. 50% of the first month’s tuition (*half of this is non-refundable)

3. Completed paperwork

* The remaining half of the first month’s tuition is only refundable if the TAS office receives a withdrawal

notice in writing at least one month before the child’s first day

A 10% sibling discount is given to families with more than one child enrolled at TAS simultaneously. The

discount is taken from the lowest tuition rate.

Extra Day requests may be granted depending on space availability if they are given in writing at least

two weeks beforehand. TAS will always work hard to meet every families need, but not every request

may be granted due to space availability both in the classes and in the vans. Days may not be traded for

other days under any circumstances.

**Important Note: Please know that, depending on the school your child attends, you may need to contact the school to provide authorization for a Timberlake After School van to pick up your child. We will let you know at enrollment if this is a requirement for your child’s school and will provide the contact information if needed. If it is required, it’s a crucial part of registration at TAS and must be done before we can pick up your child from school.

A Few Additional Notes:

Tuition is due in full on the 5th of each month regardless of vacations, illnesses or school

closures. It will be considered late after the 5th of the month and a $25.00 fee will be charged to

your account. Invoices are not mailed, but may be attained if requested. Each family is expected

to keep their account current, including the payment of late fees.

http://www.timberlakechurch.com/afterschool


Tuition rates are based on an academic year and broken down into 10 month increments.

Therefore, tuition rates are the same each month: September through June regardless of

school breaks. All early releases and public school closure days that fall on a day that your

child is already schedule to attend are included in tuition.


Enrollment Form All Information Will Be Kept Private

Child’s Information Full Name

M/F

Nickname Date of Birth

Home Address

Resides With: (Circle One) Mother/Father – Mother Only – Father Only – Mother/Stepfather – Father/Stepmother – Grandparents – Guardian

Requires Booster Seat?

Parent/Guardian #1 Information

Full Name Relationship to Child

Address

Home Phone Number

Cell Phone Number

Occupation

Work Phone Number

Email Address

Instructions on the best way to contact parent/guardian in case of an emergency

Parent/Guardian #2 Information Full Name Relationship to Child

Address

Home Phone Number

Cell Phone Number

Occupation Work Phone Number

Email Address

Instructions on the best way to contact parent/guardian in case of an emergency

Sibling Information

Name

Birthdate

Name

Birthdate

Name

Birthdate


Do you currently attend Timberlake Church? (Circle One) Yes No Are you a member? (Circle One) Yes No Please tell us how you became aware of TAS:

Please help us get to know your child by writing something about him/her (i.e. likes/dislikes, favorite activities, favorite foods, personality traits):

If you answer “Yes” to any of the following questions, you may be contacted by our office staff for further information:

Question Yes or No Please List/Describe

Has your child been tested or treated for concerns with speech, hearing, physical, emotional or social development?

Does your child have any food allergies?

Does your child have any allergies other than food allergies?

Does your child have any medical conditions (i.e. asthma, diabetes, chronic illness, etc.)?

Does your child take any prescription medication?

Does your child need to take this medication at TAS? If yes, you will need to fill out a medication authorization form with instructions from your child’s doctor

Has your child had any surgeries?

Does your child have an IEP?


1. Have there been any special circumstances at home (i.e. divorce, remarriage, adoption, moving, new sibling, etc.)? 2. What kind of behavior management techniques do you frequently use with your child? 3. Is there anything else you would like us to know about your child?

Thank you for enrolling your child in Timberlake After School! Feel free to contact us with any questions!


Emergency Information

Emergency Contacts In the event that we cannot reach either parent or guardian please list whom we may call to pick up your child. Children will not be released to individuals who are not on this list. Please contact our office immediately should this information change. Name Relationship to Child Telephone Numbers

Out of Area Contact (required in the case of a natural disaster) Name

Relationship to Child

Main Phone

Additional Phone

Authorization to Release Child It is TAS policy that children must be picked up by a parent, guardian, or other authorized person. This section is to add additional pick up people other than the emergency contacts listed above. If a child is to be picked up by someone not on the ‘Authorization to Release Child’ section on your child’s registration, the parent must provide written authorization giving the name of the person picking up the child. A photo I.D. is required at pick up. We will not release children to an unauthorized person. Authorized persons must be eighteen years of age or older. Name Relationship to Child Telephone Number(s)


Preferred Sources of Medical Care for Your Child Child’s Physician Physician Phone Number

Child’s Dentist Dentist Phone Number

Hospital Name Hospital Phone Number

Health Insurance Company Policy Number

Date of Last Physical Exam

Are there any medical problems, allergies, or special conditions that health care professionals would need to know while they are treating your child? (Circle One) Yes No If “Yes”, please describe: Consent for Medical Care and Treatment of Children: I hereby give permission that my child, , be given emergency treatment to include First Aid and CPR by a qualified staff member at Timberlake After School. In the event that I cannot be contacted, I further authorize and consent to medical, surgical and hospital care, treatment and procedures to be performed for my child by a licensed physician or hospital when deemed necessary or advisable by the physician to safeguard my child’s health. I waive my right of informed consent to such treatment. I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct: Parent/Guardian Signature: Date:


Schedule Request

Required Enrollment Fees:

Registration Fee: $100.00 or $150.00 per family (non-refundable)

Tuition Deposit: 50% of first month’s tuition (50% is non-refundable)

Please Check the Schedule You’re Requesting:

Monday-Friday (Full time: $422.00 monthly tuition)

Monday/Wednesday/Friday (3 days a week: $283.00 monthly tuition)

Tuesday/Thursday (2 days a week: $170.00 monthly tuition)

What is your requested start date?

Which school does your child attend?

What grade is your child entering in the Fall?

**Important Note: Please know that, depending on the school your child attends, you may need to contact the school to provide authorization for a Timberlake After School van to pick up your child. We will let you know at enrollment if this is a requirement for your child’s school and will provide the contact information if needed. If it is required, it’s a crucial part of registration at TAS and must be done before we can pick up your child from school.


Electronic Funds Transfer Form

$ Registration Fee: ($100.00 per child or $150.00 per family; one time only)

$ 50% 1st

Month Tuition: (50% of tuition down payment is non-refundable) $ Activity’s Fee: ($60.00 – may pay now or pay with first month’s full tuition; annual)

$ Total: Amount to be billed to credit card/checking account at enrollment.

I hereby authorize my financial institution to make periodic payments on my behalf from the checking, savings or

credit account listed below and transfer it to Timberlake After School.

I understand that I am in full control of my payments and I will notify you if at any time I decide to make any

changes, discontinue this service, or change or close my credit card or bank account.

The tuition amount to be billed to my credit card/checking account monthly is: $ .

Name (as printed on the account or card used)

Address

City

State Zip

Signature

Date

Financial Notes:

Tuition payment is ONLY accepted via automatic credit card billing or automatic Electronic Funds Transfer (EFT) or check.

Tuition is due in full regardless of vacations, illness or school closures.

A 10% sibling discount on the lower tuition is given to families with more than one child enrolled in TAS simultaneously.

Extra days may be granted, space permitting, for an additional fee. Part time days may not be traded for other times or days under any circumstances.

Tuition is due on the 5th of each month. A late fee of $25.00 will be charged after the 5th of the month. Payment for all late fees is due when you pay your tuition. All families are expected to keep their accounts current.

We accept Visa, Mastercard, and Discover Card.

Credit Card Charge

Visa Mastercard Discover

Credit Card Number

Expiration: Month/Year

Checking Account

Account Number

Routing Number (attach voided check)


Financial Agreement Your child is now formally enrolled in Timberlake After School. Tuition for the program schedule you have selected is due in advance. The registration fee and twenty-five percent (25%) of the first month’s tuition are non-refundable. 1. Tuition Payments:

A. Monthly tuition is due by the 5th of the month

B. A late fee of $25.00 will automatically be applied after the 5th of the month if tuition is not paid in full. My child may not be accepted for care until the monthly tuition plus the late fee are paid in full.

C. TAS cannot give credit for days your child is absent. As such, there is no reduction in tuition

when your child misses a day due to vacation or illness.

D. I understand there are a limited number of students who can attend TAS and insufficient notice of withdrawal may prevent TAS from enrolling another child. Therefore, after providing written notice of intent to withdraw, I assume responsibility for one more month’s (30 days) tuition.

E. Students who enroll or withdraw in the middle of a month may pay a prorated tuition fee, if the

parents provide TAS with the proper written notice. 2. Late Pick Up Charges: Students may be picked up from TAS at any point in the afternoon until 6:15. After 6:15, the parent/guardian is considered late and the following steps will be taken:

A. The first time a parent/caregiver is late, a verbal warning is given. B. The second time a parent/caregiver is late, a written warning will be given. C. The third time a parent/caregiver is late, and for any incidences after that, the parent will be

charged five dollars ($5.00) for every 5 minutes he/she is late. We understand that unavoidable or emergency situations might occur on rare occasions, causing a parent to be delayed. The Director will assess emergency situations on a case-by-case basis in determining late-fee assessment. 3. NSF Checks: There is a $25.00 charge for all NSF checks. In the unlikely event Timberlake After School (TAS) must seek collection of past due fees, I agree to reimburse TAS for reasonable collection fees and interest on past due amounts. I have read the Financial Agreement and accept the conditions as stated. Signature: _________________________________ Date:________ ______


Consent Form

Please return this form to Timberlake After School prior to your child’s first day

Child’s Name: Parent’s Name (Printed):

x

Van Consent

I hereby give permission that my child, , be picked up from school in a

Timberlake After School van in accordance with the schedule I chose upon registration in Timberlake

After School (TAS). I understand that it is my responsibility to inform my child’s school and/or teacher of

his/her transportation schedule and will not hold TAS accountable on days that are not included in the

original agreed upon schedule per my monthly tuition.

Signature: Date: x

Field Trip Release

I hereby give permission that my child, , may attend those field trips

that are a part of the Timberlake After School program during the 2012/2013 school year. I do hereby

release and discharge TAS from any liability or claim or cause of action that I may have in the future as a

result of any injuries received by the said child while s/he participates in the field trip.

Signature: Date: x

Photo Release

I hereby authorize and consent to the use of my child’s visual image by TAS for appropriate

purposes, including but not limited to: still photography, videotape, electronic and print

publications and websites. I give this consent with no claim for payment.

Signature: Date: x

Parent Directory

Please complete the back of this form indicating whether you wish to have your contact information included or excluded from the Parent Directory. All information printed in the directory is for TAS parents and staff only.


Please mark the appropriate box:

No. Please OMIT my information from the Parent Directory.

YES. Please INCLUDE my information, as shown below, in the Parent Directory.

If you indicated above that you would like your family's information included in the Parent Directory, please fill in the information below that you would like included. Information that you would NOT like included should be left blank.

Child’s Information Child’s Name

Birthdate

Grade

School

Parent/Guardian #1 Information Parent/Guardian Name


Address

Home Phone

Work Phone

Cell Phone

Email

Parent/Guardian #2 Information

Parent/Guardian Name


Address

Home Phone

Work Phone

Cell Phone

Email


Emergency Kit Instructions

Please provide a kit for each child in care. All perishable items must be replaced every six months. Place

all items in a quart or one gallon zip lock bag and mark your child’s name and the date each time the kit

is updated.

Emergency Kit Contents

Quantity Item Description “X”

1 Emergency “space” blanket

(small rectangular package;

available at REI)

1 Emergency light stick (available

at REI or hardware store)

1 Family Photo

2-3 Granola or energy bars (foil

wrapped)

1 Hand wipes (small bag)

1 Juice box

1 Kleenex (small package)

1 Letter or note of support written to your child, with emergency contact telephone numbers.

1 Stuffed animal or cuddle toy

(very small)

I acknowledge and understand the above list. I will purchase the necessary items for my

child/children’s emergency kit as soon as possible and turn in the completed kit by my child’s first day.

_______________________________________ _________________

Parent/Guardian signature Date

4505 236th Avenue NE Redmond, WA 98053 Phone

Documents

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