Suttons Bay KIDS CLUB by bzs14448

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									                             Suttons Bay KIDS CLUB                                                        Return this form to:
                                                   ENROLLMENT FORM                                       8257 E Governmental Dr Ste 107
                                                                                                               Suttons Bay MI 49682


                                  4-H KIDS CLUBS of Leelanau County
          YOUR CHILD (REN)
          Child 1

          Name: ________________________________________________________ Grade: _______ Birth date: ________________



          Address: _____________________________________________________________________________________________
          Child 2

          Name: ________________________________________________________ Grade: _______ Birth date: ________________
          Child 3

          Name: ________________________________________________________ Grade: _______ Birth date: ________________
          Child 4

          Name: ________________________________________________________ Grade: _______ Birth date: ________________

              PARENT INFORMATION
          Parent 1


          Name: ______________________________________________ Workplace: _____________________________


          Address (if different):______________________________________________________________________________________________

          Home Phone: ______________________________ Cell: ___________________________ Work___________________________________


          Parent 2


          Name: ______________________________________________ Workplace: _____________________________


          Address (if different):______________________________________________________________________________________________

          Home Phone: ______________________________ Cell: ___________________________ Work___________________________________

                PLANNED ATTENDANCE
          ____PRESCHEDULED


                     _____ MON.          _____ TUES.           _____ WED.          _____ THURS.         _____FRIDAY


          _____ FLEXIBLE SCHEDULING Must be scheduled at least 24 hours prior to attendance.




A one-time, non-refundable fee of $25 per child (or $40 per family) is collected with all new enrollments. A renewal fee of ten dollars is charged to every
family prior to the summer and fall sessions. You will be mailed a full registration packet once your enrollment form and fee is received.


Please review the information on the back, sign and return this form to KIDS CLUB in your school or the address at the top of the page.


Signature_______________________________________________________ Date _________________________
                                            4-HKIDS CLUBS of Leelanau County
                                        Suttons Bay Before & After-School Program

To ensure high quality programming for your child the following requirements must be met:
     KIDS CLUB operates daily 7 A.M. until school starts and after-school until 6:00 P.M.
     KIDS CLUB fees are based on enrollment, not attendance.
     KIDS CLUB charges by the event (after-school day), not by the hour.
     Absences due to illness, vacations and other issues require payment.
     Flexible scheduling requires at least 24 hour prior notice via signup, note, or phone. You will be charged for any and all days
        you commit to verbally or in written form.
     Two (2) week notice must be given in order to accommodate changes in scheduling; i.e. extra-curricular activities such as
        play practice, sports, scouts, etc.
     KIDS CLUB will not be open on days when school is closed for inclement weather.
     KIDS CLUB is available for scheduled in-service and early release days. You will be asked to sign-up for those days in
        advance and will be billed for those days whether you attend or not.
     All children should be picked up by 6:00 P.M. each evening. A late pick up fee of $10 is charged for the first fifteen (15)
        minutes after 6 P.M. and $1 per minute additional for each minute after.
     A PARENT HANDBOOK will be provided to all enrolled families. The handbook details all policies.

         FEES
                 All new enrollments are charged a one-time fee of $25 per child or $40 per family.
                 4-H assesses a $10 per student participation fee each year.
After-school:                      Prescheduled                        Flexible Scheduling
                                   $8 per child per day                $9 per child per day
Half-Day:                          $15 per child per day               $17 per child per day
Full Day:                          $25 per child per day               $27 per child per day

PAYMENTS                   Billing occurs at the beginning of each month with payment expected at that time.
Flexible Scheduled families are billed a month in arrears. Payments received after month end are subject to a $10 late fee.
Families who are chronically late or have received a collection notice will be dropped from the program until all fees are current.
Checks are made out to: 4-H KIDS CLUB-Leelanau Billing questions should be addressed to the County Coordinator.

Financial Aid             Child Care Assistance is available to families through the Dept. of Human Services. The phone number for
the Grand Traverse/Leelanau office is: 941-3900. This assistance is usually for a portion of child care costs with the families
responsible for the remaining amount. Limited special circumstance assistance is available through the Leelanau County Family
Coordinating Council. See your Site Director for more information.

Special Circumstances
The Site Director is available to discuss any concerns you may have about your child or the program. We’ll do our best to schedule a
time convenient to all concerned. Operational, billing, or policy concerns may be directed to: Laurie Sohasky, the Leelanau County
Coordinator via email: SohaskyL@MSU.EDU or phone (231) 590-8987. Families who are experiencing financial difficulties should
contact Laurie @ 590-8987 to arrange payment extensions.


“KIDS CLUB, a place where kids and friendships grow!” We hope to become part of your extended network of family and friends
who are out there doing what is best for kids. Welcome to 4-H KIDS CLUB!



                    You will be mailed a full registration packet once the enrollment form and fees are received.
                                        For additional Info about Suttons Bay KIDS CLUB Call:
                         KIDS CLUB ROOM 271-8607 or Laurie @ 590-8987 or email SohaskyL@MSU.edu

         Please mail your completed form and check to: 4-H KIDS CLUB c/o Suttons Bay Elem School
                                                           PO Box 367 310 Elm St Suttons Bay MI 49682
         Or: MSUExtention-4-H KIDS CLUB 8257 E Governmental Dr Suite 107 Suttons Bay MI 49682

								
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