Levittown AM Program - Levittown Public Schools

LEVITTOWN PUBLIC SCHOOLSLevittown Memorial Education CenterAbbey LaneLevittown, New York 11756“SUCCESS FOR EVERY STUDENT”Mike GattusLevittown A M Program Coordinator(516) 520-1342THE LEVITTOWN MORNING PROGRAMIMPORTANT INFORMATIONIn order to provide a safe and affordable child-care setting prior to school hours, the Levittown Public School District offersa before-school program. LAMP, the Levittown A M Program, is open to students who are entering kindergartenthrough grade 5 in September and who reside in the Levittown School District and who attend the Levittown PublicSchools. The program is housed in all six of our elementary schools. Some basic information follows:The program will begin on Friday, September 5, 2014.The hours are from 7:10 AM to 9:00 AM each day school is in session.Please be advised that there is no adult supervision prior to 7:10 AM, and the schools are not open prior to7:10 AM. All students must be brought into each building and checked in, at the door, with the teacher incharge.The fee for the program is $100 per child per month.Payment for September will be accepted the first week of the program. Payment for subsequent months is dueby the fifth school day of each month. Please make your check payable to Levittown Public Schools, or you maypay on Pay-Schools. A $10 late fee will be charged after the 5 th school day of each month. A $20 late fee willbe charged after the 10 th school day of each month.Following is some important information about registration for the program:Parents must complete a registration form, an enrollment agreement and a medical emergency form. These formscan be obtained on our website at www.levittownschools.com under the Academics tab. In addition, hard copiescan be picked up in the main office of the elementary schools or in the Department of Instruction at the LevittownMemorial Education Center.When completed, please return all forms to the Levittown Public Schools Department of Instruction, 150 AbbeyLane, Levittown, NY 11756 by August 1, 2014. Any applications received after August 1 st will only be accepted ifspace is available.Faxed copies of the LAMP application will not be accepted.Please note that we are asking for two names for emergency contact. It is imperative that we have the names ofpeople who live locally and are available from 7:10 AM to 9:00 AM to respond in the event of an emergency.Please supply your emergency contact people with the last four digits of your social security number. This will beused as an identification code for contact purposes only.If you have any questions or concerns, please contact Mr. Gattus at 520-1342. If no one is available, leave a message andyour call will be returned as soon as possible.

Levittown A M ProgramREGISTRATION FORM(Please print neatly)Only original registration forms will be accepted. One form per child.We do not accept faxed copies of LAMP applications.School YearSTUDENT NAMEStart DateDATE OF BIRTHSTUDENT ADDRESS HOME PHONE #MaleFemale# DAYS ATTENDING THE PROGRAM Which daysHOME SCHOOLFATHER’S NAMEGRADE as of SeptemberMOTHER’S NAMEWORK PHONE # WORK PHONE #CELL Phone # CELL Phone #SOCIAL SECURITY # XXX – XX - SOCIAL SECURITY # XXX – XX -(last four of S. S. #) (last four of S. S. #)NOTE: The last four numbers of your Social Security number will be used as a code for identificationpurposes only. Please be sure your emergency contact person knows this identification number. You mustprovide at least 2 emergency contacts that live within 5 miles of the LAMP site your child attends.LOCAL EMERGENCY CONTACT #1NAMEADDRESS PHONE #--------------------------------------------------------------------------------------------------------------------------------LOCAL EMERGENCY CONTACT #2NAMEADDRESS PHONE #-------------------------------------------------------------------------------------------------------------------------------PHYSICIAN’S NAME PHONE #□ Please check if child is over 55 pounds(In the event that CPR must be administered, this information is needed.)Medical Problems: allergies, medications, physical limitations, etc. Please list all that apply.___________________________LAMP SCHOOL ATTENDINGPlease return to Levittown Public Schools LAMP Program, Dept. of Instruction, 150 Abbey Lane, Levittown NY 11756 byAugust 1, 2014. Applications received after that date will only be accepted based on space availability.

LAMP ENROLLMENT AGREEMENTFirst month’s tuition is payable before the end of the first week of the LAMP Program inSeptember.Tuition payments are due the first of each month. Payment is by check or money orderonly. If tuition payments are NOT received by the 5 th school day of each month, a $10.00late payment fee will be added to my bill. After the 10 th school day, a $20.00 late paymentfee will be added.PLEASE READ CAREFULLYIf my check is returned for insufficient funds, a fee of $10.00 will be added to my bill. If this happenstwice, I will be responsible to pay by cash or money order each month thereafter.Under no circumstances will my child be released to anyone without a phone call or writtenauthorization from the parent/guardian. Proper identification is required to pick up children. No studentswill be released to anyone under 16 years of age.LAMP reserves the right to call the emergency numbers and arrange for someone to pick up childrenwho appear to be ill, show signs of contagious illness, or if LAMP has to close early, due to anemergency (this includes very heavy snowfalls).I must inform LAMP of any special needs, medical concerns or problems my child may have.LAMP has the right to exclude my child from the program if I do not meet the responsibilities of thiscontract.LAMP has the right to exclude my child from the program if proper behavior is not displayed.I have read this agreement carefully and agree to the contents.Please checkParent / GuardianDateStudent’s NamePlease Print Neatly

LEVITTOWN PUBLIC SCHOOLSLevittown Memorial Education CenterAbbey LaneLevittown, New York 11756“SUCCESS FOR EVERY STUDENT”Mike GattusLevittown A M Program Coordinator(516)520-1342LEVITTOWN A M PROGRAMMEDICAL EMERGENCY FORMI ____________________________________________ give permission to the Teacher-in-charge ofthe Levittown A M Program to administer minor first aid only (apply sterile bandages to cuts andice to bumps) to my child ___________________________________.(Please print neatly)In the event of a medical emergency, if I, or the emergency contact persons, I have listed cannot bereached, I authorize the Teacher-in-Charge of LAMP to take the necessary steps to provide medicaltreatment for my child including authorizing emergency medical treatment at a hospital.________________________________Parent/Guardian signature_______________________________Date_______________________________Medical Insurance Carrier________________________________Phone #________________________________ID #

ALL APPLICATIONS SHOULD BESUBMITTED BY AUGUST 1, 2014.APPLICATIONS RECEIVED AFTERAUGUST 1, 2014 WILL BE ACCEPTEDSUBJECT TO SPACE AVAILABILITY.