Consent Forms:

• I here by give my consent to have my child to participate in all activities at GoFun Learning
• I hereby give my consent to have my child to participate in all food programs, including all meals and  snacks at GoFun Learning
• I give my permission to have my child taken to GoFun Learning from school, including on various field  trips, by means of transportation used by GoFun Learning
• I also realize that GoFun Learning will not be responsible for any minor injuries which might occur  anytime during program(s)
• My child must be in 6 grade or higher and at least 12 years old to sign themselves in or out.

I authorize GoFun Learning to allow my child to sign themselves in or out of the program. I  understand there are no crossing guards since school is not in session during our business hours.

*Restriction applies. Please see site director for details.

Authorization for Emergency Medical Treatment:

In case of an emergency, GoFun Learning will attempt to reach “Emergency Contact” on the enrollment page in  the order provided. If for any reason we are unable to reach the aforementioned person, I authorize GoFun  Learning to use emergency services and have them transport my child to the nearest medical facility. I also  grant permission to perform any emergency procedure at the discretion of that receiving medical facility. GoFun  Learning may authorize all necessary medical procedures that are deemed vital for the health of my child. I also understand every effort will be made to contact my child’s physician or me immediately, and that medical  procedures will be implemented only in the event that I cannot be reached and/or under emergency  circumstances. GoFun Learning will not normally distribute medication unless the parent/legal guardian  presents a signed medical form by the student’s physician labeling each medication with clear instruction on 1.  Amount, 2. Time and Frequency to be taken, accompanied by a written consent signed by the parent/guardian.

Discipline Policy:

We believe that children learn from their role models and parents play a vital role in their development as well  as any adults who look after them. GoFun Learning expect all staff to treat children in respectful manner and for  children to respond in the same way to everyone in GoFun including staff and other students. Children who are  demonstrating inappropriate behavior will be handled professionally using counseling techniques. In a more  serious situation such as biting, fighting, and/or the use of improper language, the child will meet with the Site  Director for further discussions. The parents may also be contacted to help developing a remediation process.  However, repeated chronic misbehavior may result in dismissal from the program if no improvement is  observed. Parents demonstrating inappropriate behavior to staff, students, or other parents will also result in  their child being dismissed from the program.

Influenza Virus Brochure:

INFLUENZA VIRUS, THE FLU, A GUIDE TO PARENTS: Child care facilities, family day care homes and large family  child care homes should provide parents with information detailing the causes, symptoms, and transmission of  the influenza virus (the flu) every year during August and September. My signature verifies receipt of the  brochure on the “Influenza Virus, The Flu, and A Guide to Parents”: A copy can be printed online at  www.gofunlearning.org

Media Release:

AUTHORIZATION FOR MEDIA RELEASE: I understand that GoFun Learning and any grant funders may use  photographs and/or digital videos of my child for local publications, advertisings, or any other related  promotional medium. I waive the right to inspect or approve any photographs or digital video images before  they are published and any use to which they may be put. I have read the above and hereby give my consent.

Payment Policy:

REGULAR PROGRAM FEE: See payment schedule/flyer for payments and a non-refundable registration fee cost.  Tuition is due along with the registration fee, made payable to GoFun Corp.  

GRANT FUNDED PROGRAM FEE: If GoFun Learning receives grants from any funding programs, fees will be based on a sliding scale according to income. There is a nonrefundable registration fee. Spaces are limited. The  above fee schedule is normal rate without grant funding or if there are no spaces left for grant funding.  

PAYMENT POLICY & PROCEDURES: Payments will only be accepted by cash, check, or credit card. All payments  must be made prior to the start of the attendance period. A 5% of processing fee will be charged with credit  card payment. There are no refunds. If a payment is made late, a $10 late fee will be added each day, until full  payment is made. Payments are made monthly. If no payment is received after 7 days from its due date, your child will be dropped from the program and may no longer attend. You will need to re-register your child and  pay an additional registration fee, if seats are available. The above schedule of fees will apply for children of all  age levels according to the license age limits at your site. 

RETURNED CHECKS: There is a returned check charge of $40.  

LATE PICK-UP FEES: After 7:00 p.m., the charge is $1.00 for every minute until the child is picked up. This is  strictly enforced and will be payable when the child is picked up. After 3 late pick-ups GoFun Learning reserves the right to drop your child from our enrollment.  

I acknowledge receipt of the “Fee Schedule” to be paid by me for my child’s attendance at GoFun Learning. I  understand that in the event I fail to pay these charges timely and collection procedures are started or suit is  initiated to collect unpaid charges, I will be responsible for all collection cost along with late payment fee.

PAYMENT Due Date: Are due before the program starts and on the first Monday of every month. Failure to  pay in advance will result in a child’s non-participation in the program and an immediate dismissal. I understand  that there will be no refunds, credits, or reductions in fees. Student will be required to be re-registered  including registration fees.

REFUND POLICY: GoFun Learning provides partial period refunds in very limited and specific cases to individuals  who qualify due to the conditions listed below.

• student has unexpectedly lost his/her primary dwelling due to natural disaster or other documented  state of the homelessness.
• student is unexpectedly hospitalized or home bound due to a medically diagnosed physical or  mental condition.
• student unexpectedly loses a parent or legal guardian.
• discontinues or cancels a service or program for which the child has been registered for.

Make-up Lessons

• If a student can’t attend a lesson, notice must be given no later than 24 hours before the lesson. The earlier the  better, so we can try to accommodate/reschedule a makeup lesson. Makeup lesson schedule is dependent on  teacher’s availability. If absence notice is not given, or given later than 24 hours in advance of the lesson, then  the lesson will be charged, and no makeup lesson will be rescheduled. Make-up lessons cannot be rescheduled.
• Advance notice is important for coordinating and rearranging the schedules of other students and parents. It  takes time for everyone to adjust their schedule, travel arrangements, etc.
• Please arrive to lesson on time. Tardiness (arriving late to lesson) will not be accommodated with make-up time.

Illness

If the student is not up to lesson that day due to illness, a new assignment or notes can be sent through email  upon request. If a student has difficulty playing his or her instrument but is still able to attend lesson, we can  have an alternative lesson plan, such as music appreciation, musician theory, ear training or aural training  (rhythm, interval, chords, etc.).

Parent Information:

PLANNED ACTIVITES: Shall include, but are not limited to snack time, arts and crafts, music, math, science,  homework sessions, technology, indoor games (blocks, board games, bowling, puzzles, coloring, table tennis)  and outdoor games (playground time, kickball, soccer, basketball, tag, relay races, basement, softball,  badminton). Children should always wear school approved clothing and footwear.

FESTIVITIES: Throughout the year we have many festivities that your child may participate in. We have holiday  and birthday celebrations that may include food. The following list is a sample of the foods that your child may  be served during our operation. By signing this form you are agreeing to have your child participate in our  program and be served the foods we provide. If your child has or recently develops a type of food allergy, please notify us immediately. Students will not be served any of the foods provided unless this consent form is  signed. Thank you for your cooperation.

List of foods that may be served:

- Fruit Cups - Cheese - Donuts - Juice Boxes - Popcorn  - Bagels - Chicken Nuggets - Frosting - Marshmallows  - Pudding - Bread - Chips / Pretzels - Hamburgers - Milk  - Rice Cakes - Cake - Cookies - Hot Dogs  - Nutri Grain Bars - Sandwiches - Candy - Cotton Candy  - Ice Cream - Pies - Whipped Cream - Cereal  - Crackers - Ice Pops - Pizza - Yogurt

PARENT INFORMATION: Parents are expected to follow our rules and obey the laws. If a parent’s actions cause  disturbance or is deemed threatening, the program administrators may need to take appropriate actions,  including calling 911, restrict parent from campus, or exit the child from our program.

HIPPA PRIVACY STATEMENT: The After-School and Music Program will protect the confidentiality of students  according to federal, state, and local laws.

CELL PHONES: In the event of cell phone misuse the child will relinquish the phone to a GoFun Learning staff.  The phone will be returned to the authorized registered adult signer at the time of pick-up.

COURT ORDERED DOCUMENTS: Should you have court ordered paperwork for any parties who are not able to  have contact with your child enrolled in GoFun Learning, please give the paperwork to your Director at time of  enrollment. Paperwork must be an official court ordered document and indicate who the primary residential  guardian is or indicate there is shared parental custody. This must be updated annually. Occasionally we are  asked to give copies of sign in/out sheets or attendance records. Please know that in order to obtain any records  from GoFun Learning, we must be subpoenaed for them.

PARENT AUTHORIZATION:

Separated Parents: If parents are separated, but not legally divorced, the staff has no right to deny access to a  child by either parent. If one parent is concerned about the safety of the child when the child is with the  noncustodial parent, action should be taken through the court system. Without court order, GoFun Learning will not deny access to the child by either parent.

Divorced Parents: In the case of divorce, either parent may pick up the child unless a court order indicates  limited visitation or no visitation. If parents are in the process of separation or divorce while the child is in  GoFun Learning’s care, every attempt should be made to keep staff members updated on issues affecting  custody or emotional well being. Custody agreements must be kept on file at the site.

STUDENT MEDICATION POLICY：

STUDENT HEALTH: Registering adults are responsible for notifying GoFun Learning of any unusual health  concerns for their child when they register the child in our programs and as time goes on. If the child requires  any type of medication at any time, the registering adult MUST read this policy and fill out necessary  documentation BEFORE GoFun Learning makes a determination whether or not the child can participate safe  program.

MEDICATION DISPENSING POLICY: GoFun Learning staff shall not administer or dispense any kind of medication  to any student without written consent of the registering adult and a completed treatment plan signed by  physician. GoFun Learning reserves the right to decide not to administer medication if it is determined that the  circumstances warrant medical training and/or unreasonable responsibility for our staff and for the safety of the  child. If medication treatment is approved by GoFun Learning’s administration, the personnel administering  medication or providing treatments in accordance with this policy shall not be held liable for civil damages.

RULES:

• An Authorization for Medication/Treatment Form must be completed. The information required on this  form shall include a treatment plan, signed by a physician and a signed parental consent for all medicine.  Execution of the parental consent and physician section will grant the Site Director or his/her designee  the permission to assist in the administration of all medications and shall the necessity for the  medication to be provided during the after school hours, including when the student is away from our  program for field trips. The written treatment plan signed by a licensed physician shall include possible  side effects, purposes, and special instructions regarding the medication. Medication may only be given  when the physician and parental consents arecomplete. This form is required for students with chronic  and acute illnesses. Copies of the completed forms must be place student’s folder.
• All approved medications shall be administered by the GoFun Learning’s coordinator, site director or  his/her designee. GoFun Learning staff will NOT administer any medication that requires a needle  injection with the exception of an epi-pen
• Medications may be administered by the GoFun Learning’s coordinator, site director, or his/her  designee when there exists an illness and that requires maintenance-type medicine, and when failure to  take medication could jeopardize the student’s health and that medication administration schedule  cannot be accommodated before or after GoFun Learning Program(s).
• All medication to be administered shall be received, counted and stored in its original container and  shall be properly labeled with student’s name, name of drug, directions concerning dosage, time of  day to be taken, name of the prescribing physician, date of prescription and shall not exceed the  dosage required for one week of acute illnesses.
• A medication log of all students receiving medications will be kept by the site director or his/her  designee.
• GoFun Learning shall store all medications in the original container in a secure fashion under lock and  key, and is accessible only to the school coordinator/site director or designee.
• No elementary student shall transport medications to or from school.
• GoFun Learning staff administering medications in accordance with this policy shall not be liable for civil  damages.
• When specific training is required to dispense student medication, it is the parent’s responsibility to set  up and arrange the training for our staff.

I have read and understand GoFun Learning’s “Student Medication Policy”. I understand that GoFun Learning  has the right to determine if they are able to safely administer the needed medication for my child in order to  participate safely in their programs.

If you have any questions or concerns, please contact us at (312) 483-0335 or email us to info@gofunlearning.org