2010 Summer School and Summer Camp Brochure and Appilcation

8/9/2019 2010 Summer School and Summer Camp Brochure and Appilcation

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For more information, please contact:

Clear Horizons Academy

5455 N. River Run Dr.Provo, UT, 84604

801-437-0490

[email protected]

Summer CommunityCamp and Summer

School

Summer 2010

5455 N. River Run Dr.

Provo, Utah, 84604

801-437-0490

[email protected]


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Clear Horizons Academy is pleased to

announce our newly reformatted Summer

School and Summer Camp Programs. We

anticipate an increase in student skills,

progress and sociability, and have added a

parent training element to this years

program.

Summer Community Camp (options A & B):

Our exciting new addition, SummerCommunity Camp, is designed to:

include parents add new experiences practice flexibility and community goals

Based on enrollment, students will be dividedinto groups of 5 to 12 students. Each groupwill attend twice/week for 3 hours (11am-2pm). Both of these days, students, parentsand staff will venture on a community outing.Each group will be assigned two CHA staffmembers: one teacher and one paraeducator.In order to allow one-on-one assistance aswell as opportunities for parent training,networking and relationship building,parents/caregivers get to attend WITH theirchild! By having a parent/caregiver attend the

community trips, CHA staff members will beable to focus on training and coaching eachchilds parent/caregiver on how to work ongoals, through difficulties, and evenexperience triumphs out in the community.

Each child enrolled* will be accompanied by aparent, grandparent, home-therapist, sibling(if at least 18 years of age), or neighbor. Foran additional fee (to cover staffing costs),

you may request CHA to provide a staffmember to attend with your child. To offerthis exciting training to parents, as well as to

keep tuition as low as possible for families, weare offering two different pricing options:one for families providing a caregiver, and onefor families requesting a CHA-providedparaeducator.

*Please note that only a caregiver may accompanyyour child each day. Additional siblings or friendsnot enrolled in the program will not be able toattend. This is to help everyone focus exclusivelyon the individual goals and needs of CHA SummerCommunity Camp students.

Summer School (options B & C):This year, we have two Summer Schoolsessions available, each meeting from 9:15-3:15 twice/week. CHA will group SummerSchool enrollees into either aMonday/Wednesday or a Tuesday/Thursdaygroup, based on student levels and peermatching. Students will follow a typical schoolday schedule, with activities such as art,academic rotations, small & whole groupactivities, movement, lunch, social groups, andrecess. Each child will be placed in the classmost appropriate for his/her needs. Eachclass will have one teacher and an appropriatenumber of paraeducators to support thenumber of students in the classroom. If yourchild is in need of a one-on-one paraeducator,we will contact you regarding details prior toacceptance.

To register:

Simply fill out your registration form, includepayments and information and return it toCHA ASAP! Priority registration for currentCHA students is due by May 7th. After that,all open spots will be offered to thecommunity.

Option A: Summer Community Camp

Dates: June 14 July 22Times: M/W or T/Th, 11am-2pmCosts: $390 total which includes outing costs

(based on $65/week or $32.50/day or$10.83/hour)**

** Add $530 to have CHA provide a paraeducatorin place of providing your own caregiver on thecommunity trips.

Option B: Summer School Only

Dates: June 14-July 22Times: M/W or T/Th 9:15-3:15****Costs: $695.00 (based on $115.83/week or

$57.91/day or $9.65/hour)

****There isan option for 4 days/week of justSummer School. However, due to limitedspace, these spots are by application and CHABoard approval only. If you feel that this isthe only beneficial option for your child, pleasecontact CHA administration for an applicationand pricing.

Option C: Summer School AND Summer

Community Camp

Dates: June 14 - July 22Times: M/W or T/Th 9:15-3:15 and M/W or

T/Th 11am-2pm (two days of SummerSchool, alternating w/two days ofSummer Community Camp)

Costs: $1,085 total which includes outingcosts (based on $180/week or$45.20/day or $10/hour)***

***Add $530 to have CHA provide a paraeducatorin place of providing your own caregiver on thecommunity trips.


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2010 CHA Summer School & Summ

2010 CHA Summer S

StudentInformation

Childs Full Name:

Date of Birth:

Home Address:

Mothers Name:

Employer Name:

Employer Address:

Fathers Name:

Employer Name:

SummerCommunityCamp

Caregiver

Information

I will provide my owncaregiver informationto help maintain consithroughout the cours

I would like Clear HorCommunity Camp wit

I will not be enrolling

Caregiver #1 Name:

Home Address:

Email:

Caregiver #2 Name:

Home Address:

Email

er Community Camp Application

To complete your suthe following: Student Regi Medical & E $50 Deposit

hool & Summer Community Ca

CurrentlyFormer CNew CHANon-CHAGender:

Ma

Home Phone:

Mobile Phone:

Work Phone:

Email:

Mobile Phone:

Work Phone:

caregiver for CHAs Summer Community Camp, anbelow. I understand that while the caregiver can cstency for my child, no more than two individualsof the program.

izons Academy to provide my child with a paraedu. I understand my tuition will be higher, as descri

my child in CHAs Summer Community Camp prog

Relationshi

Home Phon

Mobile Pho

Relationshi

Home Phon

Mobile Pho

Page 1 of3

mer camp registration, please return

tration & Information (completed)ergency Information (completed)

(non-refundable)

p Registration

attending CHAA Student

StudentStudent

le Female

d have provided thehange from week to week,

ill attend with my child

cator to attend the Summered below.am.

to Student:

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to Student:

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2010 CHA Summer School & Summer Community C amp Application Page2 of3

Options&

Pricing

Options Dates Days Times Costs

Option A:

SummerCommunity

Camp

June 14th July 22nd

M/WOR

T/Th11am- 2pm

$390 total

Total includes outing costs.

(based on $65/week or $32.50/day or$10.83/hour)**

*For the option of a school provided paraeducator inplace of caregiver attendance on the outings, an

extra $530 for the summer may be added on.

Option B:

SummerSchool Only

June 14th July 22nd

M/WOR

T/Th

9:15-3:15

$695.00 total

(based on $115.83/week or $57.91/day or$9.65/hour)

*There is an option for a 4 days/week summerschool. However, due to limited space, it is by

application and CHA Board approval only. If youfee that this is the only option that will work for

your child, please contact CHA administration foran application.

Option C:

SummerSchoolAND

SummerCommunity

Camp

June 14th July 22nd

M-Th

11am-2pm(Camp Days)

AND

9:15-3:15(School Days)

$1,085 total

Total includes outing costs.

(based on $180/week or $45.20/day or$10/hour

*For the option of a school provided paraeducator inplace of caregiver attendance on the outings, an

extra $530 for the summer may be added on.

Note: A limited number of financial assistance scholarships will be awarded for summer school.If needed, please contact administration for more information.

Please indicate your first, second, and third preferences below.

CHA will do everything possible to accommodate everyones first preference. However, space isavailable on a first-come basis, and if there is no more room in your first preference, we will try toaccommodate your second or third preference.

1st Preference:__________________________________________ Cost: ___________________2nd Preference: _________________________________________ Cost: ___________________

3rd Preference: _________________________________________ Cost: ___________________

If one of your preferences includes Summer Community Camp, please indicate your preferencebelow: I will be attending the community trips with my child, or will provide a caregiver in my stead.

I have included caregiver information above. I acknowledge that I will not be able to bringsiblings or other children on these community trips.

I would like CHA to provide a paraeducator to go with my child on the community trips. Iunderstand that I need to include an additional $530 with my tuition to cover the cost of hiringa CHA staff member to work with my child.


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2010 CHA Summer School & Summer Community C amp Application Page3 of3

In order to hold your childs spot for CHA Summer School and/or SummerCommunity Camp, a $50 registration deposit must be included with yourregistration. This deposit includes a field trip T-shirt for both the child and thecaregiver. We ask that children and caregivers wear these T-shirts to outingactivities to help keep everyone together out in the community. $25 of this depositwill be credited towards your childs camp tuition.

Childs T-shirt size: 1st caregiver T-shirt size: 2nd caregiver T-shirt size:

I understand that by registering for Clear Horizons Academy Summer School and/orSummer Community Camp, I am asking CHA to reserve a spot for my child (and a caregiver,

if enrolled in the Community Camp) to attend for the summer of 2010. If I later choose notto send my child, I understand that I will be forfeiting my $50 non-refundable deposit, andwill need to notify CHA as soon as possible.

Parent/Guardian Signature Date

Parent/Guardian Signature Date

CHA Summer Camp Scholarship Fund Contribution

I would like to help sponsor a child who could benefit from CHA Summer Camps but whomay not be able to attend without financial assistance. Included with my RegistrationDeposit you will find $_____________ to go towards the CHA Summer Camp Donor ScholarshipFund. I understand that Donor Scholarships will be distributed to those whom the ClearHorizons School Board deems eligible.

Signature: _______________________________________

Date:________________________________________


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Medical & Emergency Information: 2010 Summer Camps

Students Name (First, Middle, Last): Gender: Male Female

Date of Birth:

Address (Street, City, State, Zip): Home Phone:

Mothers Name: Work Phone: Mobile Phone:

Fathers Name: Work Phone: Mobile Phone:

Physician Name: Phone Number: Allergies (please list):

Medical:____________

__________________

Food: ______________

__________________

Plant: _____________

__________________

Animal: ____________

__________________

Other: _____________

__________________

__________________

Physician Address (Street, City, State, Zip):

Dentist Name: Phone Number:

Dentist Address (Street, City, State, Zip):

Current Medications:

Please list any other medical conditions your child may have and/or things the school and/or doctors may need to know about your child:

If you cannot be reached in an emergency situation, please list two people we can call who canassume responsibility for your child:

Contact Name: Relationship: Phone: Alternate Phone:

Contact Name: Relationship: Phone: Alternate Phone:

In an emergency or urgent situation, if I/we cannot be reached, I/we authorize Clear HorizonsAcademy to contact his/her Pediatrician and/or Dentist. This paper will provide the doctor(s) and/oremergency teams with permission to treat my child. I also accept full payment and liability foraccident or injury incurred while at school understanding that the school will do its best to keep mychild safe, but accidents and injuries do happen.

Authorized Representative Name (please print): Relationship to Student:

Parent Guardian Other:

Signature: Date:

2010 Summer School and Summer Camp Brochure and Appilcation

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