After School | Camp Fire

Child's Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Primary Phone*

Secondary Phone

Gender*

Date of Birth*

Grade Level*

School*

Membership Status*

Ethnicity/Race*

Total # in Family*

Receive Free/Reduced Lunch at School*

Yes
No

Household Income*

Special Needs/Disabilities*

Hearing Impairment
Learning Disabled
Visual Impairment
Orthopedic
Intellectual Disability
ADD/ADHD
Autism
None

List specific activities your child should NOT participate in*

List allergies or physical/health limitations*

Physician's Name

Physician's Phone

Do you work for the government or are you involved with the military?*

No
Yes

Father or Guardian's Information

Name

First Last

Relation to Child

Father
Step-Parent
Guardian

Cell/Personal Phone

Work Phone Number

Employer

Occupation

Mother or Guardian's Information

Name*

First Last

Relation to Child*

Mother
Step-Parent
Guardian

Cell/Personal Phone*

Work Phone Number

Employer

Occupation

Emergency Contact Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Relationship to Child*

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Relationship to Child

Transportation Considerations*

Please make every effort to pick your child up from the school at 6:00 pm.
If necessary, Camp Fire vans can transport children home if arrangements cannot be made to pick them up at the school at the end of the day. Take homes do not start until all other children are picked up from the vans at the school, usually by 6:15pm. Please allow extra time for this.

No, my child will be picked up at the school
Yes, my child will need to be taken to the above listed home address

Transportation Policy*

To ensure the safety of all children attending the Camp Fire After School Program, we ask our parents or guardians to please read our safety policies and discuss with your child the Camp Fire Rules for riding on the van to and from school and Harrell Park.

CAMP FIRE VAN RULES:

No Food or Drinks allowed on the van.
No fighting or inappropriate touching
No cursing or using derogatory language
No yelling or screaming
Must remain seated while the vehicle is moving
All children and youth must wear a seatbelt at all times
No destruction to interior of vans

POLICIES:
Our Camp Fire vans are capable of transporting 13 children. The staff is trained on various safety protocols and procedures to ensure compliance and safety including but not limited to:

All drivers must follow local speed limits and obey all traffic laws.
Drivers are not allowed to pass moving vehicles in a school speed zone.
Drivers are not allowed to run yellow OR red lights. (If the driver is already in motion of an intersection and the light turns yellow, the driver must continue to clear the light)
Drivers must validate any persons picking up a child from the van with a valid drivers license or state issued ID.
All children must have permission from a parent or guardian to receive transportation by Camp Fire.

I give my permission to Camp Fire North Texas to transport my child from school, to Harrell Park and back to the school drop off location designated on page one OR to transport my child home to the designated address listed.

A child’s failure to adhere to the van rules will result in consequences. These consequences will be determined on an individual case basis and can include but not limited to the following:

1st infraction- Phone call to parent or guardian.
2nd infraction- Meeting with parent or guardian to discuss child’s behavior to reach a solution.
3rd infraction- Suspension or expulsion of the child from Camp Fire.
The severity and outcome of the infraction will be determined by the Executive Director and can lead to an immediate
suspension or expulsion from Camp Fire and all future activities.

I understand that if my child violates any of the rules during transportation, and we have gone through all the infraction attempts to resolve behavior issues, then my child may be suspended or permanently

I understand and agree to the transportation policy

Transportation Policy*

We understand that parents are extremely busy. Please make every effort to pick your child up from the school. Our drivers adhere to strict safety policies and must follow all rules and regulations enforced by local law enforcement. If the van is not at your child’s designated school location at exactly 6:00 pm (6:15 pm for field trips), please know that they will arrive shortly. Delays can happen and we want to make sure all our vans reach the schools safely.

I understand that if no one is at my child’s designated school pickup location after 15 minutes of the Camp Fire van’s arrival or at the designated address provided above, and we have not received a phone call from a parent or guardian prior to dismissing, a Camp Fire staff will call the designated contacts listed above to receive or pickup my child. If all contacts have been attempted and no one is available, Camp Fire has the authority to take my child to the Children’s Aid Society, located at 1101 30th Street (940-322-3141), to safely wait for a parent or guardian.

I have full understanding of, and agree to abide by, the transportation agreement.

Initial*

Please Initial to signify your understanding and agreement to abide by the Transportation Policies.

PHOTO PERMISSION*

Camp Fire has my permission to use photographs in which my child (or ward) appears for Camp Fire publicity.

Yes
No

Behavior Policy Agreement*

Camp Fire North Texas has a ZERO TOLERANCE policy for bullying. Our programs are inclusive to all children and youth and we strive to provide a safe environment for them to thrive and learn enrichment skills. We encourage all parents to partner with our Camp Fire staff by becoming involved with your child’s well being to help them understand the behavior policies while attending the After School Program. Camp Fire understands that our staff can never replicate your role as parents, but we do want to ensure their safety while in our care. Please contact us if you ever have questions or need to speak with us regarding your child (940) 322-5209.

Please read the following policies below and discuss them with your child.

Inappropriate Behavior:

No inappropriate touching
No weapons of any kind
No drugs or alcohol
No throwing rocks or other debris (including sticks) found in the park at other children or Camp Fire property including parked vehicles.
No bullying
No fighting– This includes any youth that is encouraging, cheering or exciting others to join in or start a fight.
No derogatory, racial slang or cursing– This includes using hand gestures at staff or other children or youth
No spitting at or on another person.
NO PHONES– Social media has become an every day platform for expression. There are serious consequences for the
misuse of taking or sending pictures and cyberbullying. Please talk to your children about the appropriate uses and responsibilities of using a phone.
Because your child will be attending an After School Program with other children and youth, we do not allow recordings, video, or pictures while at Camp Fire.

The following actions listed below will be implemented if your child does not comply with the above appropriate behavior. Each infraction will be determined on an individual case basis and can include, but not limited to, the following:

1st infraction- Phone call to parent or guardian.
2nd infraction- Meeting with parent or guardian to discuss child’s behavior to reach a solution.
3rd infraction- Suspension or expulsion of the child from Camp Fire.

* The severity and outcome of the infraction will be determined by the Executive Director and can lead to an immediate
suspension or expulsion from Camp Fire North Texas and all future activities.

I have read the above Behavior Policies set by Camp Fire North Texas regarding the expectations of my child’s behavior while attending the After School Program and understand the policies are set to ensure my child’s safety.

Camp Fire does not allow weapons or firearms on the premises (Camp Fire office and Harrell Park) at any time under Texas Penal Codes 30.05,30.06 and 30.07.

I understand and agree to the behavior policy

Initial*

Please Initial to signify your understanding and agreement to abide by the Behavior Policy Agreement.

PARENTAL PERMISSION

PARENTAL PERMISSION AGREEMENT*

Yes, I have read and fully understand the above parental permission, and agree to abide by it.

Name*

Date*

Registration Fee*

Please select which semester, or semesters, your child will be attending.

Total

$0.00

*Monday*	*Tuesday*	Wednesday
Burgess	Washington	Zundy
Scotland Park	City View	Fowler
Southern Hills	Sheppard	Scotland Park
Fain	Crockett	Lamar
	Tower

*Thursday*	*Friday*
Washington	McNeil
Franklin	Barwise
Jefferson	Kirby
Cunningham	Crockett
Milam	Zundy
Haynes	Southern Hills
	West
	City View