Recent ActivityDepartment Announcements  Surround Care Application/InformationDear Swansea Elementary School Parent/Guardians, (A.M. at Luther/ P.M. at Hoyle) OR (A.M. & P.M. at Gardner) For All Luther & Hoyle Students For All Brown & Gardner Students This program is run in coordination with the schools but at no cost to the Swansea Public Schools. The program and all of its employees are funded through fees paid by parents/guardians who chose to take advantage of these services. Surround Care Staff work 7:00 A.M. until 5:30 P.M. Their responsibilities during the school day will focus mainly on supervisory duties. Small group activities (homework, board games)
Outdoor play (video or indoor games if inclement weather) Both before & after school care $15.00/day In order to hire appropriate staff for the year, the schedule that you chose for your child must stay the same for the entire school year. A school calendar has been attached for your convenience. Please note that children will only be released to their parents/guardians or anyone listed on the pick-up list located on the emergency information form. Swansea Surround Care C/O Swansea Administration Building 1 Gardners Neck Road Swansea, MA 02777 Please make checks payable to: Town of Swansea The closing date for registrations is July 31st. If you have any questions regarding this program, please contact the Director, Stacy Laberge at the Hoyle School at 508-679-4049 or 508-675-5796. Swansea Surround Care Registration Form 2009-2010 School Year Date _________________
Home Phone__________________ Work Phone ______________ Cell Phone _________________ Home Phone__________________ Work Phone ______________ Cell Phone _________________ School ____________________________ Grade ____________ Check the appropriate days & times below: Before-school care only ______ ______ _______ _______ _______ After -school care only ______ ______ _______ _______ _______ Both before & after school care ______ ______ _______ _______ _______ School ____________________________ Grade ____________ Check the appropriate days & times below: Monday Tuesday Wednesday Thursday Friday Before-school care only ______ ______ _______ _______ _______ After -school care only ______ ______ _______ _______ _______ Both before & after school care ______ ______ _______ _______ _______
Address Grade Date of Birth Parent(s)/Guardian Legal/Custodian Person with whom child resides Relationship Home Phone Mother’s Name Place of Employment Work Phone Cell Phone Ext. Father’s Name Place of Employment Work Phone Cell Phone Ext. PICK UP LIST - for Surround Care ONLY The following is a list of adults allowed to pick up, care for and /or transport my child from Surround Care at any time. Non-family students are excluded from transporting other students. For security purposes, photo identification may be requested at time of pick-up. Name Name Phone Phone Cell Cell Address Address Relationship Relationship Name Name Phone Phone Cell Cell Address Address Relationship Relationship PLEASE COMPLETE & SIGN THE REVERSE SIDE MEDICAL INFORMATION Doctor’s Name Phone Dentist’s Name Phone Does your child have an allergy to foods, bee, hornet or wasp stings? YES NO UNKNOWN If yes, what is the prescribed treatment? Does your child have any known handicaps such as hearing loss, vision problems , etc? YES NO explain: Does your child take any medication on a regular basis? YES NO Please explain: Must the medication be administered during Surround Care hours? YES NO Please explain: In the event of an emergency, your child will be transported to the medical facility determined by the responding EMT’S. It is understood that the school and Surround Care Employees, in arranging for transportation of your child to a hospital for emergency care, is acting as a medium of mercy and is not thereby assuming responsibility. I certify that I have read and understand the rules and policies outlined in the student/parent handbook. Signature of Parent/Guardian Date |
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