STRENGTHENING FAMILIES FOR OVER 40 YEARS

MSAD 58 Summer Application 21st Century Kids of Northern FRANKLIN

1. 2022 Summer Program MSAD58

  • How the Camp Will Run:

    • The 21st Century Kids of Northern FRANKLIN will provide an in-person summer camp opportunity to campers at Strong Elementary School. It is imperative that campers are able to adhere to the strict guidelines we are putting in place that make this summer camp possible. Campers will be evaluated for selection into the program based upon a number of factors, including behavior.

    • The camp will run from June 27th to August 12th. The program will be closed July 4th-July 8th.

    • There will be no fee for this Summer Program.

    • Campers will have to be dropped off and picked up at Strong Elementary School by designated adults. Parents will be required to stay in their vehicles for drop off and pick up. Staff will chaperone campers to and from their vehicle.

    • Face masks and coverings may be worn by staff and campers in any situation if they so choose to, but it is not required.

    • Camper and staff member belongings will be separated from others’ and in individually labeled containers. All personal items brought to camp must be kept to a minimum and must be labeled with the owner’s name. Campers will only be allowed to bring 1 bag with a bathing suit, towel, a water bottle, and a change of clothing to program. Absolutely no toys (land or water) or electronics will be allowed.

    • Lunches will be provided by the Summer Feeding Program at Strong Elementary School.

    • The summer program will provide fun, active, and engaging outdoor and indoor activities (when necessary) designed to maximize students' physical activity and to keep their brains from slipping into the summer slide.

    • Care to join us? We hope you will!! Please fill out an application for each of your children if you'd like to be considered for the summer program. This application is not a guarantee that you will be selected for the summer program.

    • We will notify you if your child has been selected within 3-5 business days of submission. Please call Milissa Cousins at 207-491-9842 with any questions.

    Looking forward to a safe and fun summer!

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  • Students will have the opportunity to make shirts and/or receive camp shirts this summer. Please specify Adult or Child Size.

  • Parent/Guardian

  • This program is intended for students who do not have additional educational supports. To see if your child qualifies, please call our office at 207-778-6960.

  • Emergency Contact (REQUIRED)

  • Parent Pick Up

    21st Century staff is not allowed to walk children home. The Children's Task Force is concerned with unsupervised minors walking home alone and the safety of children during this time. Please contact us at 207-778-6960 to discuss options.

  • Morning Drop Off / Afternoon Pick Up

  • Please list below 3 adults that you would like to be able to pick your child up and/or sign your child out from the program. Adults will be required to stay in their vehicles for drop off and pick up. Staff will chaperone campers to and from their vehicle.

    Anyone who is picking up your child must provide a picture ID.

  • If there is a situation where none of the listed individuals can pick up your child, you are to call the Site Coordinator with the name and contact information for who may pick them up.
    • Please drop off your child on time. The program begins at 8:30AM Monday through Friday, with the exception of the week of 4th of July. Please do not drop off your child before 8:30AM. Our staff will not be responsible for your child until 8:30AM. Your child will need to stay in your car until 8:30AM.
      • You must pick up your child by 4:30PM. The program ends promptly at 4:30PM Monday through Friday.
      • Pick up after 4:30 pm will result in a fee of $5.00 per 15 minutes late after the first occurrence. This will be strictly enforced this year. Payment must be made before your child can return to program.
      • The 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program Staff is relieved from the responsibility of looking after any child after s/he has left the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program.

    • Student Attendance

    • Attendance Requirement: If your camper is accepted into the program and does not attend within the first week of programming, they will be removed from the program. Students must attend 3 out of 5 days each week in order to remain enrolled in the program.

    • Health/Medical Information

    • For the safety and best care of your child, please check below for any of the following that apply to your child, and provide as many details as possible.

    • Additional Information

      Please include any additional information you feel would be important for us to know about your child.

    • Parent/Guardian Release and Liability Form

      Please read and sign the standard releases and permission forms that are required to attend the summer program. Thank you. If you do not agree, please mark below the release which you do not agree with.
      Coronavirus, COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a mean to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program or accessing Strong Elementary School facilities could increase the risk of contracting COVID-19. The 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program in no way warrants that COVID-19 infection will not occur through participation in the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Program or as a result of accessing Kineowatha Park facilities. If you do not agree to send your child to the program after reading this disclaimer, this will affect your child's acceptance into the program.
      I authorize the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program and the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program Staff to contact my child via Zoom for online learning opportunities. If you do not agree, this may affect your child's acceptance into the program.
      I authorize the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program and the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program Staff to arrange for transportation in case of accident or acute illness of the participant. It is understood that every effort will be made to contact the parents or other priority person before treatment is given but that treatment will not be withheld if a parent cannot be reached. In the event it is not possible to receive instruction for the participant’s care, consent is given to any EMS or licensed physician for treatment. I allow the EMS staff and/or physician to administer medication and to perform necessary treatment for the preservation of the participant’s health and well-being. I understand that any cost incurred for treatment of sudden illness or accident shall be paid by me. This authorization and consent for treatment is given to the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program and in conjunction with any authorized event. If you do not agree, this will affect your child's acceptance into the program.
      I hereby assume full responsibility for any risk of illness, bodily injury, death, or property damage and/or while using the premises or any facilities or equipment hereon. I understand that this program includes physical activity and I also understand that any program or sport that includes such activity carries with it an inherent risk of physical injury. I further agree to hold harmless the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program, their partners, directors, officers, employees, agents, and volunteers from any and all claims that may result from any action for damages, included but not limited, to such claims that may result from injury or death, accident or otherwise, during or arising in any way from said activity. I acknowledge that this General Release of Liability of the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program, its partners is binding on me and my heirs, personal representatives, and successors. If you do not agree, this will affect your child's acceptance into the program.
      As your child is enrolled in the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program, funded by Maine Dept. of Education through funding from the US Dept. of Education our use of this funding requires that we report certain results to the Maine DOE & U.S. DOE including free and reduced lunch status, special services, academic progress, student MEDMS (school identifier) number, attendance, discipline, behavior, surveys, activity participation, and classroom performance. In addition to compliance with reporting requirements, use of this data assists program managers to make informed decisions about program adjustments and improvements, matching students with needs, program sustainability, and program replication in other sites. Our reporting of positive student results may increase our chances of securing continued and additional funding to operate this program. All information collected will be restricted and used solely for serving student needs and approved program evaluation purposes. If you do not agree, this will affect your child's acceptance into the program.
      The 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program may take long distance or walking-distance field trips during some programming hours. These field trip locations and dates will be shared with parents and guardians. We will always return by normal dismissal time, unless we notify you in advance. I give permission for my child to leave Kineowatha property under supervision of the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program Staff, Partners, and Volunteers. While taking part in these community field trips I release the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program from responsibility for any risk of bodily injury, death, or property damage as covered in the “General Release of Liability”.
      I hereby consent to the use of my child’s name, likeness and speech in any audio tape, video tape, film or photograph made in any 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program activity for the business or publicity purposes of the program and its partners. Publicity may include posts on our “21st Century Kids of Northern Franklin” Facebook Page (@21stnorthernfranklin). We encourage you all to “like” us on Facebook to get the latest updates regarding the program. I understand that any participation offers no remuneration and that my child’s name, likeness, and speech may be edited, produced, recorded for distribution throughout the United States and abroad. I expressly release the 21st Century Kids of Northern F.R.A.N.K.L.I.N. Summer Program and its licensees, assignees, affiliates and successors from any privacy, defamation, or other partners have arising out of broadcast, exhibition, publication, or promotion of this program.

    • Parent/Guardian Signature

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