Extended Day Program Vendor Guidelines - Francis Parker School

AFTER-SCHOOL PROGRAM FOR 2013-2014
Welcome to the After-School Program at Francis Parker School. We look forward to offering opportunities
for students (K-12) to become involved in after-school activities of an academic, artistic, or fitness nature.
The following forms are to be completed by each prospective vendor and forwarded to the Extended Day
Program Office upon completion (6501 Linda Vista Road, San Diego, CA 92111). Vendors will be contacted
with a final approval and room assignment.
Some changes for the 2013-2014 school year include:
New pay structure.
All registrations will be processed on-line via the Francis Parker School website. (Please note new
information which must be included on all promotional material on the following pages.)
Information and forms are available at www.francisparker.org under the “Campus Life/Extended
Day” link.
Screening expenses for TB tests and CPR/First Aid Certifications are the responsibility of the
vendor.
Please contact Mrs. Cindy O’Donnell with any further questions at (858) 569-7900, extension 4109.
Thank you,
Tim Katzman
Cindy O’Donnell
Director, Summer & Extended Day Programs
Coordinator, Summer & Extended Day Programs
Francis Parker School
Francis Parker School
650l Linda Vista Road
6501 Linda Vista Road
San Diego, CA 92111 San Diego, CA 92111
(858) 569-7900, ext. 4236 (858) 569-7900, ext. 4109
Site Locations:
Lower School - Mission Hills Campus - 4201 Randolph Street, San Diego, CA 92103, (619) 298-9110
Middle & Upper Schools - Linda Vista Campus - 6501 Linda Vista Road, San Diego, CA 92111, (858) 569-7900

AFTER-SCHOOL PROGRAM GUIDELINES
Welcome to Parker’s After-School Program. This document outlines requirements for all After-School
Programs using school property. Contact the program office at (858) 569-7900, ext. 4109 with any
additional questions or concerns.
Mail or drop off the completed application and screening forms (for each instructor and substitute) to
Francis Parker School, Attn: Cindy O’Donnell/Summer & Extended Day Programs, 6501 Linda Vista Road,
San Diego, CA 92111.
Courses/activities shall be offered during normal after-school hours when school is in session but
not during school breaks, legal holidays or on weekends.
Any instructor (including substitutes) must be included on the application form and have
completed the screening process. No instructor will be allowed on-site without prior clearance.
Once the application is approved, room assignments will be made.
Completion of the following information is REQUIRED:
After-School Program Application Form – The application must be completed in full and must be
legible and accurate. Incomplete, expired documents or illegible applications will be returned.
Access to school property will not be permitted until the application is approved by the Summer &
Extended Day Program office.
After-School Program Screening Form – For each instructor and all substitutes, a California
Department of Justice (CA DOJ) background check (contributing agency will be the program’s
organization) must be completed. No other background check is acceptable.
Tuberculin Test Clearance (with medical facility address and telephone number) must be
completed by each instructor and all substitutes. Copies must be included with the application
package; please do not send originals. (Tests are valid for four years.)
Disclosure Statement (on application form) must be completed by each instructor and all
substitutes.
First Aid/CPR Certification must be current and valid, completed by each instructor and all
substitutes. Copies must be included with application package; please do not send originals. (Online
certifications are not acceptable.)
Emergency Data Form must be completed for each instructor and all substitutes.

Statement Acknowledging Requirement to Report Child Abuse to be completed by each
instructor and all substitutes.
Vehicle Identification Form must be completed by each instructor and all substitutes who will park
on the Linda Vista campus. A decal will be provided for all vehicles for the Linda Vista campus
only.
Liability Insurance – Proof of general liability insurance coverage ($1,000,000 minimum) must be
provided naming Francis Parker School as additional insured. This proof of liability shall be verified
by the Extended Day Program Office and a copy of the policy held on file with the application. If a
policy expires during the term of the course/activity, an updated copy will be requested.
* NEW FOR 2013-2014*
Promotional Materials Distribution – For promotional materials distribution at site or to Parker
families, approval is required PRIOR TO COPIES BEING MADE OR DISTRIBUTED. A copy is to be
attached with the application paperwork. All promotional materials shall include the following
statement:
To register: Visit www.francisparker.org and choose the Campus Life/Extended Day link. If you are
unable to register on-line, contact Parker’s Extended Day Program office at (858) 569-7900, ext.
4109 for assistance.
* NEW FOR 2013-2014*
Compensation – All service providers will be provided a class list prior to the start of class naming
the children registered to date. It is the vendor’s responsibility to ensure the list matches the
attendees as vendors are paid for those registered at the conclusion of the class. Of the fees
collected, the following payment plan is applied:
Students Vendor Parker
1-5 50% 50%
6-10 60% 40%
11-15 70% 30%
16+ 80% 20%
For example, 20 students @ $100/each = $2,000
Students Amt. Received Percentage
Vendor
Parker
(Vendor/Parker)
1-5 $500 50/50 $250 $250
6-10 $500 60/40 $300 $200
11-15 $500 70/30 $350 $150
16+ $500 80/20 $400 $100
Total $1300 $700
If the total fees collected exceed $600 per year, Parker will provide a 1099 tax form.
All applications must be complete, legible, and accurate. Incomplete, expired documents or illegible
applications will be returned to the course/activity coordinator for completion. Use of school property or
any school facility will not be granted until the application is approved by the Extended Day Program
Office.

AFTER-SCHOOL PROGRAM APPLICATION FOR 2013-2014
This information is to be completed by the course/activity coordinator or director
(one form per course or activity)
The intent of the After-School Program is to extend opportunities to students (K-12) to become involved in
after-school activities of an academic, enrichment, artistic, or fitness nature. Each course/activity shall
ensure compliance with all legal requirements with the Extended Day Program office of all activities
performed within this framework. All activities must enhance and enrich students’ lives, expand
educational opportunities, and channel students’ energies constructively and safely. It is the responsibility
of each course/activity coordinator to renew all expired documents, including expired documents,
required for instructors and substitutes.
School Site ___ Lower School ___ Middle School ___ Upper School
Organization
Address
___________________________________________________
___________________________________________________
Course/activity Coordinator ___________________________________________________
Telephone Number
Email Address
Instructor(s)
Organization
Course/activity Title
Course/activity Start Date
Course/activity End Date
_______________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
__________________________ (if more than one session is being
offered, provide additional start/end dates on reverse of this page)
__________________________
Recurrence Day __ Monday __ Tuesday __ Wednesday __ Thursday __ Friday
Course/activity Time Begins _______________ Ends _______________
Course/activity Description
___________________________________________________
___________________________________________________
In accordance with the Extended Day Program guidelines, I agree to provide all necessary screening forms as noted for all
instructors and substitutes regarding courses/activities we wish to offer at Francis Parker School. I agree to keep all expiring
records updated. Financial records will be submitted as required by Francis Parker School’s Controller.
Signature of Course/Activity Coordinator
Date
_________________________________________
______________________

AFTER-SCHOOL PROGRAM
INSTRUCTOR SCREENING FORM
This information is required annually for each instructor and all possible substitutes.
(Substitutes not processed will not be allowed on campus.)
The course/activity coordinator must provide evidence to the Extended Day Program office for
meeting employment requirements. Required documents must be legible, accurate, valid, and
current.
Each instructor or substitute must provide to the course/activity coordinator the following
information:
Completed Screening Form
Tuberculin Test Clearance
Completed Disclosure Statement
First Aid/CPR Certification
Emergency Data Form
Child Abuse Form
Vehicle Identification Form (if parking on Linda Vista campus)
Instructor Name
__________________________________________
Position Instructor ___ Substitute ___
Organization
Course Title
__________________________________________
__________________________________________
Disclosure Statement
Please note this disclosure statement is valid only for the 2013-2014 school year.
Have you ever been convicted for an offense (misdemeanor or felony) other than a minor traffic
violation ___ Yes ___ No
Signature of Applicant _____________________________________
Date ________________

INSTRUCTOR EMERGENCY DATA FORM
Please complete this form and advise of any changes as they arise in the future.
Name
Address
City/State/Zip
Home Telephone
Cell Telephone
Email Address
___________________________________________________
___________________________________________________
___________________________________________________
_______________________________
_______________________________
_______________________________
Person(s) to call in case of emergency:
Name
Relationship
Work Telephone
Home Telephone
Cell Telephone
Name
Relationship
Work Telephone
Home Telephone
Cell Telephone
___________________________________________________
_______________________________
_______________________________
_______________________________
_______________________________
___________________________________________________
_______________________________
_______________________________
_______________________________
_______________________________
Physician
___________________________________________________
Daytime Telephone _____________________ Evening Telephone ___________________
I hereby give consent to Francis Parker School to obtain emergency medical care prescribed by a duly licensed
physician should an event arise where I am incapable of obtaining said care for myself and agree to hold harmless
Francis Parker School in such event. I authorize the release of the medical information contained on this Emergency
Data Form for the purpose of assisting either a medical provider or a lay person in providing emergency medical
assistance. I understand my right to receive a copy of this form. This authorization to release such information is
only valid for the school year for which it was submitted.
Signature __________________________________________________
Date _______________________

STATEMENT ACKNOWLEDGING REQUIREMENT
TO REPORT CHILD ABUSE
Name
Social Security Number
Organization
Course Title
__________________________________________
__________________________________________
__________________________________________
__________________________________________
Position Instructor ___ Substitute ___
Section 11166 of the Penal Code requires any child care custodian, medical practitioner, or
employee of a child protective agency who has knowledge of or observes a child in his or her
professional capacity or within the scope of his or her employment whom he or she knows or
reasonably suspects has been the victim of child abuse to report to a child protective agency
immediately or as soon as possible by telephone and to prepare and send a written report
thereof within 36 hours of receiving the information concerning the incident.
“Child care custodian” includes the teacher, licensed day care worker, administrators of
community care facilities licensed to care for children, foster parents, and group home personnel.
As an instructor at our facilities, your position falls within the definition of “child care custodian.”
Therefore, you are mandated to comply with the child abuse reporting requirements as stated
above.
I, ____________________________________________, have read and understand the
requirements of PC Section 11166 as outlined above and will comply with those provisions.
Signature _____________________________________________________ Date __________________

TB TEST REQUIREMENTS
California state law requires ALL individuals who come in daily contact with students have a
tuberculosis screening (within the last four years).
The screening must be done by your doctor or at any of the following San Diego County Health
and Human Services agencies (and is at your expense).. You may not begin with the School until
this test has been done.
LOCATION HOURS TELEPHONE FEE
5202 University Ave.
City Heights, CA
Monday & Wednesday
8:30AM – 11:00AM
1:00PM – 4:00PM
(619) 229-5400 $8.00
5055 Ruffin Road
San Diego, CA
Monday, Tuesday, Wednesday &
Friday (No Thursday)
8:00AM – 11:00AM
1:00PM – 4:00PM
(858 ) 573-7300 $8.00
460 N. Magnolia Ave.
Suite 110
El Cajon, CA
Monday, Tuesday, Wednesday &
Friday (No Thursday)
8:00AM – 11:00AM
1:00PM – 4:00PM
(619) 441-6500 $8.00

FINGERPRINTING REQUIREMENTS
To:
Re:
All Employees
Fingerprinting Requirements – CA Education Code, Sec. 33192(a)
CA Education Code, Sec. 33192(a) requires all persons employed by private schools to OBTAIN A CRIMINAL
RECORD SUMMARY WHICH IS TO BE SUBMITTED TO THE EMPLOYER AS A CONDITION OF EMPLOYMENT.
The criminal record summary must be obtained from the Department of Justice (DOJ). In order to initiate
the criminal record check, the employee must be processed at a Livescan site. This will result in a check of
both California and the Federal Bureau of Investigation criminal record files. All results of the fingerprint
application will be returned to the employer by the Department of Justice.
Livescan service is available at the San Diego Unified School District, 4100 Normal Street, San Diego. YOU
MUST TAKE THE ATTACHED APPLICANT SUBMISSION FORM AND SHOW A PICTURE I.D. IN ORDER TO BE
PROCESSED.
An individual may obtain a copy of his/her criminal history record (Sections 11120 through 11127 of the
CA Penal code). All requests of this nature must be referred to the DOJ. Law prohibits the school from
providing an individual with a copy of your criminal record summary.
Livescan service is available at the San Diego Unified School District, 4100 Normal Street, San Diego, CA
92103. SDUSD’s phone number is (619) 725-7016.
Hours: Monday - Friday 8:00 a.m. – 1:00 p.m. Walk-ins only
2:00 p.m. – 4:00 p.m. Appointments only
(Last appointment: 3:40 p.m.)