COMMUNITY WORKS PROGRAM AGREEMENT

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. 

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 Agreement.

Community Works Parent- 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. 

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’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. Below may vary depending on the Site Director’s discretion.

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

Second behavior incident: The child will lose a privilege (e.g. swim day). The parent, child and Site Director 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 has full autonomy to suspend or remove a student from the program, immediately. No fees will be refunded if a situation of this nature occurs.

Personal Belongings/Attire – I will not send my child with any valuables or personal belongings. Cell phones will be taken at first sight and given back to the parent/guardian at pick-up. Cameras, toys, games, and any other electronic devices are strictly prohibited. I will send my child in appropriate attire: athletic shorts or pants, t-shirt and closed-toe athletic shoes with socks.  I understand that my child will be sent home for the day if he/she is not dressed appropriately. Community Works is not responsible for any lost or stolen items. 

CW Medical / Medicine Policy  – Parents are responsible for contacting Community Works and their Site Director directly with any updated health information for their child. 

Illness – I will not send my child to camp if he/she is ill or injured. Parents will be contacted immediately for any child who is at school with any of the following symptoms: fever, vomiting, diarrhea, uncontrolled asthma, ringworm, unspecified rashes, pinkeye, head lice, infectious disease, moderate trauma. Scrapes and minor bruises will be attended to at school and child will return to class. Children with the above symptoms must be picked up within a reasonable amount of time. 

Chronic Illness/Allergies- All students with chronic conditions such as: asthma, allergic reaction, diabetes, respiratory distress, seizure disorder, urinary frequency or incontinence must inform Community Works and the Site Director at the beginning of the program or beginning of diagnoses to discuss any health/emergency care plans which must accompany orders signed by the child’s physician for medication or treatment. 

Field Trips – I understand that it is my responsibility to get my child to the site on time. If I am late to drop off my child, he/she will miss the field trip and not be able to stay at the program that day. 

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