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© 2010 by MBAF
Manhattan Beach
Athletic Foundation
PO Box 1585
Manhattan Beach CA
90267-1585
MBAF TAX ID: #02-0603467



 

Pennekamp Elementary School
Spring Session # 3: April 26 - June 21, 2010

General Information | Class Descriptions | Class Schedules | Application | Payment

Directions: The General Information Page contains important information. At the bottom of the General Information Page, you will be directed to the Class Descriptions Page which will describe your class choices. At the bottom of the Descriptions Page you will be directed to the Class Schedule Page which will let you know when the classes meet. At the bottom of the Class Schedule Page, you will be directed to the Application Page. Filling out and submitting an application will automatically direct you to the "payment" page. If you have already submitted your application and you ONLY need to make a payment, then click here to go directly to the Payment Page. Do NOT do so if you have not submitted an application.

Application


Enrollment information:
• You must fill out a separate registration form for each student.
• No application will be considered without payment and all information requested.
• To enroll after the first week, please contact the on- site coordinator in addition to
   online or hard copy registration.
• Classes are filled on a first come basis and may be cancelled due to insufficient enrollment or adjusted to an earlier time for all students.


(Fields with * MUST be filled in!)

Student's Name*

Student's Sex*

Grade*

Teacher/Room #*

Best Parent E-Mail*

Parent's Name *

Parent's Address*

Home Phone* Pref. Emergency Phone* Caregiver Phone

My child may walk/bike home after school without Parental Supervision?

Is your child enrolled in EDP? (Please answer yes or no)*   
If yes, on which days?

Any activities affecting dismissal time for students (Gr. 1-5)?


Name(s) of persons other than parent authorized to pick-up student at dismissal:


CLASS CHOICES
DAY   
TIME
1.
2.  
3.
4.
5.
6.


PENNEKAMP ELEMENTARY AFTER SCHOOL PROGRAM CONTRACT

Reporting to enrichment activities: All students in grades 1-5 will report to the outdoor lunch area at regular school dismissal. First graders will be picked up the first week of classes ONLY. Although attendance is taken daily by the After School Program staff, the staff is not responsible for children who do not report to class.  Afternoon Kindergarten students  will be escorted by a Program staff member to the 2:45 Snacktivity.

Parent pick up: Please pick up on time at the outdoor lunch area. There is no dismissal from the class location. A fee of $1/minute will be charged for pick up after the end of the enrichment class.

Refund Policy:  There are no refunds for missed classes. A $25 fee will be charged for insufficient payment or for a class dropped after the first week of the session.

EDP: Please notify EDP of after school classes in addition to providing this information on this form.

Photos: On occasion photos may be taken during classes. Parent signature indicates permission.

cancelled classes: In the event of a class cancelled due to last minute unforeseen circumstances, every attempt will be made to schedule a make up or double class. If not possible, a refund for the cancelled class will be given.

PENNEKAMP ELEMENTARY AFTER SCHOOL STUDENT CONTRACT:
I will attend class regularly. I will follow procedures for reporting to enrichment program. I will behave appropriately according to all Pennekamp rules and regulations and will follow all guidelines of the program.

PENNEKAMP ELEMENTARY AFTER SCHOOL DISCIPLINE POLICY:

At Pennekamp we are fortunate to be able to provide an enrichment program after school.  In order for the program to continue to be a success, it should not be a substitute for after school day care.  Your child must want to participate in the classes you have chosen.  The instructors are not expected to take time away from the entire class to discipline students who are not following directions or do not wish to be in the class.

Hence, for the benefit of all students, the following policy will be enforced.

First action: A phone call will be made to inform you that your child has created a disturbance in class or has demonstrated other inappropriate behavior. Second action:  A follow-up phone call will be made by the Program Coordinator or Director if the problem persists. Third action: The student will be removed from the program for the remainder of the session without refund.
Remember, at Pennekamp, character counts.  Please sign below to indicate that you are aware of program policies and have discussed them with your child.

EMERGENCY MEDICAL CONSENT FORM

Student's Name (For Consent Form)*
*
 Parent or Guardian (Dr./Mr./Mrs./Ms.)*



Emergency Contact 1*: Daytime Phone: Cell/Page:
(you may enter "same as sibling name" if you have filled out a sibling form)

 Emergency Contact 2*: Daytime Phone: Cell/Page:
(you may enter "same as sibling name" if you have filled out a sibling form)

 Physician Name, Address, Phone*:
(you may enter "same as sibling name" if you have filled out a sibling form)

Hospital Name, Address, Phone*:
(you may enter "same as sibling name" if you have filled out a sibling form)

Is there any medication student MUST take during school hours?


Are there current health problems or allergies to drugs or foods (specify)?


Date of last tetanus booster?


Any other information that program staff should be aware of in order to best care for your child:?


PLEASE CAREFULLY REVIEW APPLICATION BEFORE SUBMITTING!
After submitting, within seconds, an on-line e-payment form will automatically be forwarded to you.
Note! You are NOT registered until your e-payment form is completed and sent.

NAME OF PERSON FILLING OUT FORM*

E-MAIL OF PERSON FILLING OUT FORM*
An online parent signature indicates acceptance of all guidelines and policies stated in these forms.



If you encounter problems filling out this form, e-mail us at Pennekamp Information


Contribute To MBAF
The Manhattan Beach Athletic Foundation is a federal tax-exempt organization
(FEIN 02-0603467) and your contributions are tax-deductible. All contributions
will be directed to athletic, physical education and certain academic enrichment
programs of the Manhattan Beach Unified School District.
To contribute, click here.

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