* IN-PERSON PROGRAMMING*

COMMUNITY WORKS PROGRAM AGREEMENT

ENROLLMENT: Registration is required before a child may participate in the program. 

DISCIPLINE: Disruptive or disrespectful behavior toward other students or staff will not be permitted and will be cause for dismissal from the program. Please see Parent-Student pledge for more information.

MEDICINE DISTRIBUTION:No medication can be administered or consumed unless both a doctor and a parent/guardian have submitted the appropriate forms and medication to the CW Site Director. We strongly encourage families to dispense both temporary and maintenance medications outside of program hours.There are no nurses during the Community Works Program on duty. Community Works can not guarantee that a trained medicine disbursement individual is on site at all times. Medication needs to be in the original container with the appropriate prescription label (including the name of the student, the name of the medicine, the date, the dosage information, and directions for administering the medication) and the appropriate LA Administration of Medication Form. We store and administer the medicine in a secure location. Please be aware that the medication cannot travel back and forth to program – once it’s given to us for your child’s use, it must remain with us until it needs to be refilled. Therefore, we strongly encourage you to ask for two separate prescriptions when at the doctor’s office with your child. Students are not allowed to have medication (prescription or nonprescription) of any kind in their possession at the program and it should not be placed in their bags. One adult in the presence of a second adult, with the exception of a life-threatening emergency, shall administer medication. A log of medication administration, by individual, will be kept. The log will contain the name of the student, the name of the medication, the dosage to be given, and the time to be given. The person giving the medication will record the date and time of the administration of medication and sign their name. The witness (second adult in attendance) will initial the log. If an error is made in recording, the person who administered should line out, initial the error, and make the correction in the log. If any adverse reaction to medication occurs, the parent/guardian will be notified and if necessary, 911 shall be called. At any time the use of an Epi-pen is administered, it MUST be followed by a call to 911. 

STUDENT TO INSTRUCTOR RATIO (or SUPPORTING STUDENTS WITH ADDITIONAL NEEDS): Community Works Programs will enforce  COVID-19 procedures via Student to Instructor ratio.

RECORDS: CW requires that you submit a copy of your student’s report card in December of 2021 and in May of 2022.

Your signature on this page verifies that you have read the above information carefully and agree to abide by all conditions of the Community Works of Louisiana Program.

PARENT AND STUDENT PLEDGE

Attendance/Sign Out

I will sign out my child at the end of each day. If my child is walking home or getting picked up by another adult, I will notify CW in writing. 

If you are repeatedly late, your child may face suspension or expulsion per the Site Director/Community Leader’s discretion. After 5:30 without parent contact additional measures will be taken to ensure student safety.  

Parent/Student Behavior

The CW staff will treat all parents and students with respect, kindness and patience. I will treat the CW staff with respect, kindness and patience. I will make sure that my child understands that he/she must treat fellow students and all staff members with respect, kindness and patience. 

It is strictly prohibited for my child to leave the premises without adult supervision. 

It is strictly prohibited for my child or I to touch, push, hit, fight, use profanity or lewd language towards others.  Fighting will result in an immediate one-day suspension from camp and potential removal program, per the Site Director/Community Leader’s discretion.

I understand that the following actions will be taken if my child behaves inappropriately, and I will make sure that my child understands these consequences as well. 

First behavior incident: The parent will receive a phone call.

Second behavior incident: The child will lose a privilege. The parent, child and Site Director/Community Leader will have a meeting to discuss the child’s behavior. 

Third behavior incident: The child will be suspended for one day. 

Final behavior incident: The child will be permanently dismissed.

Depending on the severity of an incident the Site Director/Community Leader has full autonomy to suspend or remove a student from the program, immediately.

Personal Belongings/Attire

Community Works is not responsible for any lost or stolen items. 

Injury/Emergency

 I understand that the Site Director/Community Leader will contact me immediately if my child becomes injured or ill. I trust the Community Works staff to use their best judgment and take appropriate action if my child becomes ill or injured.

By allowing my student to participate in Community Works and them attending one or more days, I agree to the above listed rules and regulations.