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MPACAfterschoolApplication1

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					Page 1 of 8


                                  Welcome To
                  Magnificent Performing Arts Center’s (MPAC)
                     Afterschool Program & Summer Camp

Dear Parents & Families:

We are thankful you have selected Magnificent Performing Arts Center to be a part of you and your
families’ lives. At the Magnificent Performing Arts Center’s Afterschool and Summer Camp programs
we provide a safe, academic enhancing, fun filled environment that is an affordable service to this
community and their families. Thank you for choosing to be a part of our family.

Mission Statement
Magnificent Performing Arts Center purpose is to provide children from diverse backgrounds with the
opportunity to learn music, various forms of arts and performing arts from all cultures while improving
their academic skills in a fun, safe, and nurturing environment.


         Payments are due at least one week in advance of each service period. Every child’s fee
             MUST BE PAID IN ADVANCE in order for the After School Program or
                Summer Camp to function properly. Payments must be made on time.


**All field trips are to be paid by parent or guardian upon request**

Magnificent Performing Arts Center (MPAC)
3641 Central Ave.
Charlotte, N.C. 28205
www.magnificentarts.org email: magnificentarts@yahoo.com

(704) 537-9988
Page 2 of 8


                     MAGNIFICENT PERFORMING ARTS CENTER (MPAC)
                            Afterschool Program & Summer Camp
                                   Registration Information

ANNUAL REGISTRATION FEES
Registration Fee is due at the time of enrollment. At the time of enrollment the following forms are
required, completed: 1) registration form, 2) permission to photograph form, 3) field trip permission
form, 4) emergency care information form, 5) discipline agreement (signed by parent and student), and
6) a copy of student’s latest report card. All forms are enclosed in packet.

                       One Child                        $60.00
                       Two Children                     $100.00
                       Three Children                   $140.00

Tuition is paid one week in advance--due every FRIDAY prior to providing services. If you will
not be making full payment on Friday, your child cannot return to our program until full payment of the
balance due has been made.

MPAC After School Program Offers:
*Nurturing, fun filled, safe learning environment*
*Homework Support*
*Reading & Mathematics tutorial services*
*Music Theory instruction*
*Piano Keyboard instruction*
*Private music lessons*
*Dance Classes*
*Drama*
*Age appropriate curriculum and materials*
*Indoor/outdoor recreational activities*
*Fun and Educational Field Trips
*Healthy snacks and breakfast (lunch served on teacher workdays)

Hours of Operation - Monday thru Friday
   After School Hours                                 1:30 PM – 6:30 PM
   Summer Camp, Teacher Workdays
         and Holiday Breaks                            6:30 A.M – 6:30 PM

Field Trips & Extra Curricular Activities Fees
*Parents must pay for field trips and activities upon request

Magnificent Performing Arts Center (MPAC)
3641 Central Ave.
Charlotte, N.C. 28205
www.magnificentarts.org email: magnificentarts@yahoo.com
(704) 537-9988
Page 3 of 8


                             PERFORMING ARTS CENTER (MPAC)
                              Afterschool Program & Summer Camp

                                     Financial Responsibility Form

Payments are due at least one week in advance of each service period. Every child’s fee MUST BE
PAID IN ADVANCE in order for the After School Program and Summer Camp to function properly.
Payments must be made on time.

Please be advised that the After School Program and Summer Camp is self-supporting, and as such, its
successful operation is greatly dependent on your support and timely payment of fees.
We greatly appreciate your cooperation in this matter.

                                               Late Payments
Late payments are not allowed. If an account has not been paid as specified in the Program Manual and,
therefore, is outstanding at the beginning of a service period, the following will occur:

    •   A late fee of $10.00 will be charged.
    •   The child will not be allowed in the program.
    •   The child will be kept in the office while a parent/guardian or other authorized person is
        called to pick up the child immediately.


I have received, read, and acknowledge the policies outlined in the Parent Information Guidelines for
the Magnificent Performing Arts After School Program and Summer Camp
.
    • Fees are to be paid on time and in full based on the weekly, bi-weekly payment schedule or
       monthly payment schedule. Failure to make payment prior to the first day of service period may
       result in the child being withdrawn from the program.
    • A late payment fee of $10.00 will be charged for payments not received prior to the first day of
       service period.
    • There is a late pick up fee of $10.00 per 10 minutes per child.
    • All fees are to be paid in cash, checks or money order. Bounced checks are a $35 fee.
    • Refunds and credits will only be issued if student is absent for 5 days or more consecutively.

I understand that this form will be kept in my child’s file as an official document.

Please print below:
Student’s Last Name, First Name Middle Initial: _________________________________________

Please sign and return this form to the After School Age Child Care Program indicating that you have
read and understood this notification.


Parent’s name (print)                  Parent’s signature                          Date
      Page 4 of 8



                                   PERFORMING ARTS CENTER (MPAC)
                                    Afterschool Program & Summer Camp
                                              Registration Form

Child’s Name:                                                 Date of Birth:
Home Address:
Home Phone:                                         E-mail:
Address if different from child:
Mother’s or Guardian’s Name:
Place of Employment:
Work #:                                               Cell:
Father’s or Guardian’s Name:
Home Phone:                                         E-mail:
Address if different from child:
Place of Employment:
Work #:                                               Cell:
School and grade your child is currently/will be attending?
Please share any information/your child interest?




     Parent’s/Guardian’s Signature                                       Date


      Magnificent Performing Arts Center (MPAC)
      3641 Central Ave.
      Charlotte, N.C. 28205
      www.magnificentarts.org email: magnificentarts@yahoo.com

      (704) 537-9988
Page 5 of 8


                  MAGNIFICENT PERFORMING ARTS CENTER (MPAC)
                         Afterschool Program & Summer Camp
                                 Discipline Agreement

As educators, we understand that every now and again teachers may encounter discipline problems with
students. Please help us enforce our expectations by discussing them with your children.

                               THERE WILL BE NO:
                                      *Fighting*
                       *Verbal threats or belittling of any kind*
                                      *Stealing*
                  Vandalism of MAC or anyone’s personal belongings*
                                     *Profanity*
                              *Insubordination to staff*
                                *Sexual Harassment*
                     *Physical endangerment of children or staff*
                      *Leaving MPAC without staff supervision*

**Corrective Action Plan
   1. Verbal warning (documented)
   2. Privileges revoked (documented)
   3. Conference with director, parent and child (documented)
   4. Dismissal from program

**Parents and students please be aware depending on the severity of the unacceptable behavior; any
child can be removed without completing the steps of the corrective action plan at the discretion of the
director.**


Child’s name (print)                 Child’s signature                         Date


Parent’s name (print)                 Parent’s signature                        Date

Magnificent Performing Arts Center (MPAC)
3641 Central Ave.
Charlotte, N.C. 28205
www.magnificentarts.org   email: magnificentarts@yahoo.com
       Page 6 of 8


                               MAGNIFICENT PERFORMING ARTS CENTER (MPAC)
                                      Afterschool Program & Summer Camp
                                       Emergency Care Information Form

Child’s Name:                                                              Date of Birth:
Home Address:
Home Phone:                                                    E-mail:
Address if different from child:
Mother’s or Guardian’s Name:
Name of Employment:                                                        Work #:                             Cell
Father’s or Guardian’s Name:
Home Phone:                                                    E-mail:
Address if different from child:
Name of Employment:                                                        Work #:                             Cell
Name of Pediatrician:                                               Office #:
Address:
Any allergies (food, Medicine, etc.) or other medical conditions that MPAC staff or physicians should be aware of in
the event of an emergency.


Does your child have Asthma? ___Yes ___No
If mother or father cannot be reached, please call:
Name:                                                 Phone:                                      Relationship:
Name:                                                 Phone:                                      Relationship:
Name of Medical Insurance:                                                             Policy:
** IN AN EMERGENCY SITUATION, IF THE ABOVE INDIVIDUALS ARE NOT AVAILABLE,
WHAT WOULD YOU LIKE THE MAGNIFICENT PERFORMING ARTS CENTER TO DO: _________


LIABILITY CLAUSE – I understand and agree that the Magnificent Performing Arts Center shall not be legally liable for any bodily
injuries, or the result thereof incurred and suffered, by my son/daughter on any property of the Magnificent Performing Arts Center or
while engaged in any of its activities away, unless such loss or injury results directly from negligence or a willful act of an employee of the
Magnificent Performing Arts Center within the scope of his/her employment /volunteerism.




       Parent’s name (print)                          Parent’s signature                                   Date
     Page 7 of 8


                             MAGNIFICENT PERFORMING ARTS CENTER (MPAC)
                                      Afterschool Program & Summer Camp
                             Pick Up Authorization and Authorization to Transport Form

                                               Pick Up Authorization

I authorize the following people to pick up my child:

Name: ______________ Address: ____________________________________ Phone: ______________

Name: ______________ Address: ____________________________________ Phone: ______________

Name: ______________ Address: ____________________________________ Phone: ______________

I understand that my child will not be released to anyone whose name does not appear above, unless the
director has been notified by the parent or guardian. In the event of an emergency, exceptions may be made
by notifying the director in writing or by telephone. I understand that for the safety of my child, anyone
whom picks up my child will be asked to show identification.



     Parent’s name (print)                   Parent’s signature                      Date


                                          Authorization to Transport Form


I, ___________________________, authorize ___________________________ to be transported to field
      (parent’s/guardian’s name)                        (child’s name)
trips, from school, from home, to home, or emergency facilities in MPAC vehicles. I understand that my
child is covered through MPAC’s insurance and agree that staff cannot be sued or held liable for any physical
or bodily damage while my child is being transported.



     Parent’s name (print)                   Parent’s signature                      Date


     Magnificent Performing Arts Center (MPAC)
     3641 Central Ave.
     Charlotte, N.C. 28205
     www.magnificentarts.org email: magnificentarts@yahoo.com

     (704) 537-9988
      Page 8 of 8



                        MAGNIFICENT PERFORMING ARTS CENTER (MPAC)
                               Afterschool Program & Summer Camp
                               Consent to Photograph and Videotape

Please be advised that during the year, your child may be photographed, videotaped or interviewed at various
sponsored events. With your consent, the photograph, video or interview may be reproduced and released for
use by the media, i.e., newspapers, brochures, videos, television and through the internet. Please check one:

___     I, ______________________, give permission for the Magnificent Performing Arts Center (MPAC)
        to photograph and videotape my child __________________________, for purposes of public
        awareness, newspaper articles, educational purposes, scrap books, and advertisement.

___     I, ______________________, do not give permission for the Magnificent Performing Arts Center
        (MPAC) to photograph and videotape my child __________________________, for purposes of
        public awareness, newspaper articles, educational purposes, scrap books, and advertisement.


      Parent’s name (print)                Parent’s signature                        Date

                              Permission to use Computer Lab and Internet

      MPAC After School Program and Summer Camp will be using the Computer Lab. One of the things
      the children will be doing while in the lab is surfing the internet for homework research, MMR Program
      and using MPAC’s academic programs. The Computer Instructor will be in the room assisting the
      children and making sure that they are in suitable sites. All of our computers are equipped with
      programs that filter and prohibit access to inappropriate internet sites. In order for us to allow your
      child to go on the internet, we need your consent. If you agree to allow your child to use the
      internet please fill out the following information. We look forward to seeing all of the great work
      our children will be doing. As always thank you very much for your cooperation.

      I, _____________________, give permission for my child ________________________, to use the
      internet. I understand that computers will be used only for educational purposes. I also understand that
      any student misusing the network will lose their privileges to access the internet from the
      classroom/school environment.

      I, __________________, do not give permission for my child _____________________, to use the
      internet. I understand that computers will be used only for educational purposes. I also understand that
      any students misusing the network will lose their privileges to access the internet from the
      classroom/school environment.


      ____________________________          __________________________
      Child’s Name                              Grade


      Parent’s name (print)                Parent’s signature                        Date

				
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