AUTHORIZATION FOR EMERGENCY CARE
In case of accident or serious illness, and the program site is unable to reach me, I hereby authorize Cornerstone Christian School to contact the physician indicated on the application and to follow his/her instructions: If it is impossible to contact this physician, Cornerstone Christian School may make whatever arrangements necessary to provide care and treatment for my child. In case of accident/serious illness where the immediate treatment of my child is not necessary, but he/she is unable to remain in the program, I will be contacted or transportation arrangements will be made for my child. If the program is unable to reach me, I authorize Cornerstone Christian School to contact one of the persons indicated on the enrollment form and ask them to pick up and transport my child home.
SAFETY
ALL children MUST be signed in & out by someone 18 years of age or older and identified on the student’s registration form. Any person picking up a child WILL be asked to provide identification for verification. Students will not be dismissed by anyone that does not have proper ID.
D.C.F. LICENSE NUMBER
Number #: C04DU1066
GENERAL RELEASE OF LIABILITY
In consideration of being allowed to participate in any related events and activities the undersigned agrees to the following: I acknowledge and fully understand that each participant will be engaging in activities that may involve risk or serious injury; including permanent disability and severe social and economic losses, which might result not only from their actions, inactions or negligence, but the action, inaction or negligence of others, the rules of play or the condition of the premises or of any equipment used. Further, there may be risks not known to us or not reasonably foreseeable at this time. To the best of my knowledge, my daughter/son is physically fit to engage in the activity in question. I understand that Cornerstone Christian School and their volunteers and agents will exercise reasonable care while my daughter/son is in their custody and care, engaging in activities through the Cornerstone Christian School. I agree that Cornerstone Christian School will be held harmless from any and all liability, which may arise while exercising their duty of care, relating to my daughter/son for personal injury or illness that may be suffered or any loss of property that may occur to my daughter/son while participating in the Cornerstone Christian School.
HEALTH RECORDS
I certify that my child (who is listed on this application) has been examined by a licensed physician in the past 12 months and is able to participate in the Cornerstone’s Extended Care Program. The Health History is correct as far as I know, and the person herein described has permission to engage in all prescribed activities and field trips, except as noted by the examining physician and me.
LOST OR STOLEN ITEMS
I understand that Cornerstone is not responsible for any misplaced or broken items and/or clothing. Once the classrooms are locked for the day they cannot be re-opened by any staff member. We kindly ask that students do not bring any toys to school. We provide all materials for students’ enrichment activities.
STUDENT MEDICATION
Cornerstone Christian School will not assume the responsibility of issuing medications to any child/youth. If it is deemed that we are incapable of providing routine, necessary care due to mental or physical incapacity program participation may be denied.
NOTICE OF NONDISCRIMINATORY POLICY
Cornerstone of Jacksonville, Inc. admits students of any race, color, national, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.
NOTICE IRS STATUS
Cornerstone of Jacksonville, Inc. is a nonprofit, tax-exempt, organization under Sections 501 (c)(3) and 170 of the IRS Code, and is incorporated and registered in the State of Florida. All donations are tax deductible to the extent allowed by law.
NOTICE OF TECHNOLOGY ACCEPTABLE USE POLICY FOR STUDENTS
Your child may have access to many school-related activities and technology resources, including the internet. Internet access at your child’s school is filtered, monitored and is compliant with the Child Internet Protection Act (CIPA). Your child will be required to follow the Acceptable Use Policy and guidelines that are stated in our Policy, the referenced Manual, and be bound to those terms. There is NO expectation of privacy while utilizing the Cornerstone network, computers, or any device attached to the network. Before your child uses these resources, he/she will read, be read to, and/or have the documents explained to him/her.
NOTICE REGARDING FERPA
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. Cornerstone of Jacksonville reserves the right to disclose, without consent, "directory" information such as a student's name, address, telephone number, date and place of birth, honors and awards, and dates of attendance. Parents may request that Cornerstone of Jacksonville not disclose directory information about a student. Cornerstone must be notified in writing if a parent does not want their child’s directory information disclosed.
PARTICIPATION
Cornerstone reserves the right to dismiss any child from its extended care programs offered if he/she disrupts/disturbs the program’s activities and/or the program’s overall environment as determined by Cornerstone’s Staff.
POWER OF ATTORNEY
I/we, the parent/legal guardian of the child listed on this application hereby authorize a representative of Cornerstone of Jacksonville, Inc. to administer first aid and/or transport my child to the nearest hospital or emergency care facility in the event that I cannot be reached during an emergency. I/we further authorize the hospital or a licensed doctor of medicine to administer treatment in case of an emergency. It is understood that parents will be contacted by telephone, if possible, prior to treatment. By signing this Registration Form, I/we release Cornerstone of Jacksonville, Inc. and/or Cornerstone Christian School, Inc. and/or any of their agents and/or affiliates, from any and all liability that may occur out of my child’s attendance and/or participation in any of Cornerstone’s Programs. Furthermore, in the event of an emergency I/we understand that I/we are solely responsible for any/all expenses associated with any medical treatment and/or transportation received by my child.
VOICE AND IMAGE RELEASE
By registering my child in Cornerstone’s Extended Care Program, I hereby grant the Cornerstone Christian School, City of Jacksonville and the Kids Hope Alliance, their respective licensees, successors and assigns (herein collectively called the “Licensed Parties”), the right to perpetually use, publish and copyright my name, voice, picture, portrait, likeness, occupation and testimonial in all media for the City of Jacksonville and/or Kids Hope Alliance. I understand there will be no monetary compensation for my participation in any advertising or promotion. I understand that nothing herein obligates the Licensed Parties to use my name, voice, picture, portrait, likeness, occupation and testimonial in any advertising or promotion. I release the Licensed Parties from any liability or damages resulting from the use of my name, voice, picture, portrait, likeness, occupation and testimonial in the manner described herein.
WAIVER AND RELEASE
In consideration of the acceptance of this registration form, I/we hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or pain and suffering which may hereafter occur to me and/or my minor child as a result of participation in the stated program(s). This release is intended to discharge in advance Cornerstone of Jacksonville, Inc. and/or Cornerstone Christian School, Inc their officials, officers, directors, shareholders, employees, volunteers and agents from liability, even if liability arises out of perceived negligence on the part of persons mentioned above. It is understood that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assignees. This waiver and release is intended to and does release the mentioned parties from any and all liability for damages or injuries on account of or in any way related to or growing out of my negligence, my child’s negligence, the negligence of another student, an employee’s negligence and/or the negligence of third parties, including but not limited to negligence in the construction, maintenance and upkeep of the facility and its equipment, negligence in training or negligence in supervision in addition to but not limited to negligence of Cornerstone of Jacksonville, Inc. and/or Cornerstone Christian School, Inc. and/or their agents, related companies, servants, employees, directors, shareholders, insurers, successors and assigns.
REVIEW OF STUDENT RECORDS/FILES
By registering my child into Cornerstone’s Afterschool Care Program, I hereby grant the Kids Hope Alliance and the City of Jacksonville, their respective licensees, successors and assigns; permission to inspect, review, and/or examine my child’s records/file including his/her registration form(s).
CHECK POLICY
Any checks written to Cornerstone will be deposited electronically. If a check is returned for Non-Sufficient Funds, Cornerstone reserves the right to re-run/re-deposit said check, up to 5 times over the course of a year period in an attempt to collect funds. There will be a $40.00 (or the maximum Florida allows) fee assessed for any checks or credit card payments that are returned as a result of non-sufficient funds or a stop payment.
COLLECTIONS / CREDIT REPORTING
In the event your student’s account becomes past due, Cornerstone of Jacksonville, Inc. may report the outstanding balance owed to one or more credit bureaus via a collection agency. Outstanding balances will be reported under the student’s primary parent on file and/or the primary account contact on file. In addition, you will be responsible for any court costs, attorney fees, and or collection costs that may be added. Collection fees of up to 50% may be added for the recovery of your debt permitted by law, 15.U.S.C.1692f(1)[section 808(1)].
FEES - LATE PICK-UP
After 6:00pm a late pick-up fee of $10.00 per each 10-minute increment, per student, including any portion of the increment will be due. The Cornerstone School’s staff member on duty will be the official timekeeper for said billing purposes. All fees are due at the time of pick-up. If the fees are not paid at the time of pick-up, they will be billed to the primary parent on file.
FEES - LATE PAYMENT
There will be a late fee of $25.00, will apply if monthly invoice is not paid in full by the 3rd, of each month.
By enrolling your child, I acknowledge that I understand and agree to the fees/rates stated within this application. Furthermore, I understand and agree that in the event of an outstanding past due balance on your child’s account, additional collection fees will apply.
PAYMENT INFORMATION
Fees are not prorated.
No sibling discount is available.
All payments made are non-refundable.
Fees are due in full upon being invoiced. A late fee will apply three days after the invoice date.
The Parent/Legal Guardian who signs this agreement accepts full financial responsibility for the child and agrees to pay any fees related to the child’s participation in the program.
All payments made to Cornerstone will be applied to the oldest invoice (based on the due date of each invoice). First Cornerstone reserves the right to apply any payment to any outstanding invoices on the account, including but not limited to past due sports fees, extended care, school tuition, field trips, summer camp and late fees balance(s) regardless of the payee’s request.
Failure to pay extended care fees in a timely manner will result in termination from the program.