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Big Thought
THRIVING MINDS
A Program of Big Thought


2021-2022 After School Enrollment Packet
Thank you for your interest in the Thriving Minds After School Program ("Program"). On the following pages you will find forms that must be completed by a parent or guardian in order for your student to be enrolled in the program.

Please note: "Child" and "Student" are terms that are used interchangeably throughout the following packet and forms.  Your student will not be allowed to attend the program until all required documents have been received by the Program staff. Please complete all pages in this form as soon as possible as enrollment is limited and offered on a first-come, first-served basis. 

Also, a separate application must be filled out for EACH student to be enrolled.

THIS ENROLLMENT PACKET IS SUBJECT TO UPDATE AND REVISION AT ANY TIME.

If you have questions about the program, please contact Big Thought at 214-520-0023.
List of Items Needed to Complete Form
To complete this application you will need to have the following information ready:
  1. Your student’s school ID number
  2. Health insurance information for the student (Insurance Company name and phone number)
  3. Emergency contact information (Name, phone, and email address)
  4. Approved persons who can pick up the student (Name, phone, and photo ID information)

Enrollment Update!
Currently, due to the number of students previously enrolled, which we satisfy on a first-come, first-served basis, the after school program has reached the maximum capacity, and your student will be placed on a waitlist for our program. As more spots become available, we will be sure to notify you and provide you with more information going forward. Please complete this application in order to have your student placed on the waitlist. 


Enrollment Application

Please complete all pages.  When you have finished you will submit your e-signature and then receive an email asking you to verify your email address.  Please click the link in the email to confirm it and then you have completed the application process.

Student Information









* Student ID number is available at the school's main office.


(MM/DD/YYYY)





Emergency Information
The following information is required in case of emergency. The Health and Medical form will be transported with your student to the nearest clinic/hospital to assist the paramedics and hospital staff. This form is also required to be with students during all field trips, if scheduled as part of this Program.








In case of a medical emergency, whom may we contact?















Health Information
* All medical documentation and information noted on and/or connected to this questionnaire will be handled and maintained as confidential. This information could be shared on an as needed basis.  Again, confidentiality will be maintained. 

(If Yes, details will be provided on Page 4.)


Student's Present / Past Medical History




I, the undersigned, hereby authorize Big Thought staff to contact the person(s) and healthcare provider(s) named on this form and to authorize the named physicians, clinics, hospitals, and others to provide emergency transport and healthcare to said student. In the event that the physicians, parents/guardians, or any persons named on this form cannot be contacted, Big Thought staff and school personnel are hereby authorized to take whatever action is deemed necessary to provide emergency care to said student. (paraphrase of Section 35.01, Texas Family Code). I HEREBY AGREE TO WAIVE, RELEASE, INDEMNIFY, AND HOLD HARMLESS BIG THOUGHT AND DALLAS ISD, its respective officers, affiliates, owners, directors, contractors, agents, and employees from any claims, liabilities, and causes of action asserted against BIG THOUGHT AND/OR DALLAS ISD by reason of the acts, omissions, or neglect of BIG THOUGHT AND/OR DALLAS ISD, its employees, or agents. I certify I am a parent with the legal control of the student, the student’s legal guardian, or have other court ordered control of the student. I understand that I must notify the Program in writing to change any information on this form or to revoke any consent given herein. I understand it is a penal code offense to falsify information for enrollment. I testify all information on this document to be true and correct.

Page 4

Food Allergies
Please indicate the foods that cause an allergic reaction in your child. 
Mild = reaction is barely noticeable or causes minor irritation;
Moderate = reaction may require medication or other non-emergency intervention;
Severe = reaction is potentially life threatening if not treated immediately (e.g., ambulance or immediate ER visit) 
Mild Moderate Severe




(Please describe)

(Please describe)

AUTHORIZED ADULTS
The Parent/Guardians listed below, as well as the three Contacts listed on the next page, will be allowed to pick up a student, if marked for pick-up. The information listed below will replace all existing information on pick-up contacts at the time this form is received by Program staff. No contacts are entered into the system without PHOTO ID. Older siblings may pick up provided there is a signed permission letter and photo ID of the sibling on file with the Program staff on campus.  Copies of these Photo ID's must be provided to Program staff at the Program location.
Please Note: If child cannot be released to non-custodial parent, we must have legal documentation on file.
CUSTODIAL PARENT OR GUARDIAN (Required)











Ex: State of Texas, US Gov.


SECOND PARENT OR GUARDIAN (Optional)











Ex: State of Texas, US Gov.


AUTHORIZED ADULTS, Continued
Please list up to three (3) additional contacts who may pick up your student (at least one (1) is required).  You must enter the type of Photo ID the contact has and the ID Number.
Contact 1 (Required)





Ex: Driver's License, Passport


Contact 2





Ex: Driver's License, Passport


Contact 3





Ex: Driver's License, Passport


Enhanced Health and Safety Protocols
I understand that Big Thought staff and the facility are engaging in certain activities to keep everyone safe during this public health crisis. I commit to adhering to these enhanced health and safety protocols, and to any updates to these protocols as they are made.

THE FACILITY WILL NOT PERMIT ENTRY TO ANYONE WHO:
  • Has a temperature of 100.4°F or above;

  • Has signs or symptoms of a respiratory infection, such as a cough, shortness of breath, sore throat, or low-grade fever;

  • In the previous 14 days has had contact with someone:
with a confirmed diagnosis of COVID-19; 
under investigation for COVID-19; or 
ill with a respiratory illness

I WILL IMMEDIATELY NOTIFY THE FACILITY if I, any member of my household, or anyone in my household has been in close contact with an individual with a:
  • Suspected or confirmed case of COVID-19 (for example – close contact at home, work, religious service, social gathering).

  • For medical professionals: If contact occurs while wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection), that contact will NOT be considered close contact for purposes of this protocol.

I WILL BE FAMILIAR WITH AND CONFORM TO ENHANCED PROTOCOLS. These include:
  • At arrival, a staff member will take the temperature of each student being dropped off. If the student does not have a temperature of 100.4°F or above or other symptoms of a respiratory infection, the staff member will guide the student into the program area.

  • At pick up, a staff member will guide each student from the entrance of the facility to your vehicle.   

  • I will not enter the facility unless specifically invited by facility staff. I agree to have my temperature taken prior to any invited entry to the facility. 

  • I understand that the Program ends at 6:00 p.m. I will pick up my student at the agreed time AND call the facility should there be a situation that requires me to be early, so staff can meet me at my vehicle, or late and other arrangements have been made for pick up.  A courtesy call 15 minutes before pick up is strongly encouraged to ensure expedient pick up service.

  • Big Thought and the facility will permit students to bring a change of clothes with them in a sealed Ziploc bag, to keep at the facility on an as needed basis. The bags will be wiped down by staff before being brought inside the facility. Students may not bring any other possessions with them. 
General Parent/Guardian Letter of Understanding
1. I will receive a copy of the Program's Parent/Guardian Handbook upon completing this form, and that I will review it and acknowledge and agree to all of its provisions.

2. Each student is permitted ONE written warning about unacceptable behavior.  Should unacceptable behavior occur again, the student will be dismissed from the Program.

3. Late pick-up policy: Students must be picked up by the stated Program end time. Each student is extended one no-charge late pick-up before additional fees are assessed. After the first late pick-up occurrence, Parent/Guardian will be charged a fee of $1.00 per minute for every minute late. Students who are picked up late more than five times may be dismissed from the Program.

4. Fighting is not allowed in the Program. Depending on circumstances, students may be dismissed for fighting.

5. Students must come directly to the Program area after the regular school day is dismissed. Parent/Guardians must inform Program staff in advance, should a student not be attending the Program that day.

6. If a student leaves the Program area(s) without permission from a Program staff member, the student will be dismissed from the Program. A student  must always ask permission to leave the Program area (a room or a playground, etc.), unless an obvious emergency is taking place.

7. All students are encouraged to stay to the end of the Program day to receive the full benefits of the Program activities.

8. As stated, only Authorized Adults are permitted to pick up students.  

9. I understand that Big Thought conducts an annual evaluation of the Program, and, as part of that evaluation, Big Thought may administer surveys to my student, administer academic and/or social and emotional learning assessments to my student, and may access student records in compliance with FERPA regulations. I understand that Big Thought will:

• Keep all individual information confidential to the extent allowed by law.

• Never report information on a student by name or identifying information and will only share information in the aggregate (meaning overall results), to ensure that no personally identifying information is released about a student in the Program.
 
• I also understand that my consent is voluntary. My decision whether or not to allow my student to participate in the Program assessment will not prejudice my present or future relations with Big Thought or my student's School teacher or other School official(s). If I permit my student to participate in the Program assessment, I am free to discontinue participation at any time without prejudice. I understand that if I withdraw my student from the Program, my student’s information will be removed from the project results.  I understand that I can request copies of the evaluation tools by contacting Big Thought at Shannon.epner@bigthought.org

10. As part my student's experience in the Program, my student may have the opportunity to participate in Dallas City of Learning (DCoL), an 
education initiative and online platform designed to help students discover new interests, develop skills and earn recognition for their learning achievements. DCoL is a partnership with the Dallas Mayor’s Office and Dallas ISD, and is managed by Big Thought. A portion of data that has been provided above, including the student's name, birth date, and Parent/Guardian email or phone, will be shared with DCoL to enable your student's participation.
permission for my student to participate in Program Assessment as outlined in Item #9
Informed Consent and Publicity Release
I, the undersigned, for good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, as the parent or guardian of my student, hereby (1) authorize Big Thought ("Big Thought") and its Board of Directors, officers, employees, agents, representatives and associates of their respective staff and anyone authorized by them the unrestricted and irrevocable right to photograph, video and record my student in connection with Big Thought program(s) in which my student is participating, has participated, or will participate (“Programs”) and (2) grant to Big Thought the unrestricted and irrevocable right to use, publish, reproduce, edit, adapt, modify, exhibit, project, distribute, and display such photographs, videos and recordings, and my student's name, image and likeness, voice and statements, biographical information and story (individually and collectively, the “Content”), in any form of media now known or later developed (including, without limitation, print, digital, electronic, visual, broadcast, Internet, social media, or otherwise), individually and in conjunction with other content, throughout the world in perpetuity.

Big Thought will own all of the Content and any other results generated by my student as part of my student's participation in Big Thought Programs, and any physical material to which such Content is affixed, including but not limited to any videotapes, audio recordings, photographs, print materials, canvas, poster boards or digital media, including the copyright and other rights in and to such Content and materials. On behalf of myself and my student, I hereby irrevocably assign, transfer, and convey all right, title, and interest in and to the Content to Big Thought. On behalf of myself and my student, I release and waive any claims whatsoever in connection with the use of the Content as expressly authorized above, including, without limitation, any claim of rights of privacy, publicity, copyright infringement, defamation, so-called “moral rights,” or credit. I also release and waive any right I or my student may have to inspect or approve the Content or any use thereof as expressly authorized above. Additionally, I waive the right to any royalties or other compensation relating to the use of the Content.

On behalf of myself and my student, I hereby hold harmless and release and forever discharge Big Thought and all persons, corporations or legal entities acting with its permission or upon its authority, from any and all claims, demands, and causes of action which I, my student, our respective heirs, representatives, executors, administrator’s, or any other person acting on my or my student's behalf or on the behalf of my or my student's estate have or may have by reason of this agreement or the use of the Content as expressly authorized hereunder.

I acknowledge that Big Thought is conducting its activities in express reliance upon the foregoing, and I represent and warrant that I am not, and my student is not, a party to any other existing agreement which would prevent me or my student from entering into this agreement or granting the above rights to Big Thought or which would cause the terms of this agreement not to have full force and effect.
FOR MINOR CHILD OR WARD: I, the signer of this document, represent that I am the parent and/or guardian of the minor student named above. I represent that I have the legal authority to, and hereby do, execute the preceding consent and release on behalf of such minor.
permission for Big Thought to use my student's photo, likeness, and other materials as described above.
Tuition Agreement
You are enrolling your student in the Thriving Minds After School Program ("Program") for the 2021-22 school year and agree to pay the tuition fees as set forth in this Agreement. The Tuition Agreement must be signed and returned for enrollment to be completed. By signing this Agreement you acknowledge that this Program is fee-based and that, in fairness to all Thriving Minds participants, payment is required in a timely manner.



Fee Structure
Montessori Academy at Hernandez
Hernandez Fee Structure
Highland Meadows
Lakewood Elementary
Lakewood
Payment Options
Thriving Minds After School tuition will be remitted on a weekly pre-payment basis and is due the Friday prior to each program week. (For example, if program week starts on Monday, August 23, 2021, payment is due Friday, August 20, 2021.) Tuition will not be charged for scheduled non-program days such as student holidays, school breaks, etc.
Payment Process
Payment is due the Friday prior to each program week. Payment shall be delivered to the Thriving Minds staff at your program location. Payments can be made by CREDIT CARD, DEBIT CARD, CHECK or MONEY ORDER (payable to: Big Thought). Login information for CREDIT and DEBIT CARD payments will be provided after the first week of programming.
Registration
A registration fee of $25 is assessed per application (student), and payment for the first week of programming is due the first day of the Program. If a student is withdrawn from the Program but wants to re-enroll with the Program in the future, the $25 registration fee will again be assessed.
Tuition and Withdrawal Policy
  • Tuition fees are charged on a weekly basis and not prorated for daily attendance.
  • Tuition fees are not prorated for late arrivals or early pick-up.
  • A fee of $1 per minute will be charged for late pick-up from the Program.
  • No refunds will be given for student absences (including illness, vacation, suspension, dismissal due to violation(s) described in the Parent Handbook, etc.).  At management's discretion, account credits may be given if programming is unable to be delivered.
  • If a student is dismissed from the Program for violation of a Handbook policy, a $20 processing fee will be assessed.
  • If a student must withdraw from the Program, a Notice of Withdrawal form must be completed by a Parent or Guardian and submitted to Program staff no less than one week (five business days) prior to the date of withdrawal to avoid additional tuition and late charges. If a Notice of Withdrawal is not filled out, your account may still be charged and payment must be remitted at the time of the official withdrawal.
Late Payment Policy
A $10.00 late fee will be assessed per week following a late payment. Payment is considered late if it is not made by the Friday prior to each program week. Students will be permitted to continue to attend up to five days after payment was due. After five days, students may not attend until payment is made.
I, the undersigned, understand and agree to the terms outlined in this Tuition Agreement.
After School Behavioral Contract
Your student will receive this during the first two weeks of programming.  By initialing below you acknowledge you have reviewed this document:

As a participant in the Program, I understand that I must:
  1. Follow all rules of the program.
  2. Follow rules I have during the school day.
  3. Treat all adult leaders with respect.
  4. Treat all students with respect.
  5. Report directly to the program each day.
  6. Ask for permission to leave any designated area.
  7. Fully participate in all activities offered to me.
  8. Encourage my parent/guardian to attend events.
  9. Have fun!!!!
Final Acknowledgement
The Program is not licensed by the State of Texas.

Big Thought operates in accordance with the US Department of Agriculture and Texas Health and Human Services Commission policy, which prohibits discrimination on the basis of race, color, national origin, sex, sexual orientation, age or disability.

I, the undersigned, do hereby authorize Big Thought permission, for the purpose of program evaluation, as outlined in parent handbook, to administer surveys to my child, administer academic and/or social and emotional learning assessments to my child and access student records in compliance with FERPA regulations.

I agree to waive, release, discharge, and hold harmless Big Thought and its directors, officers, Trustees, employees, agents, and assigns, from any and all liability, claims, demands, suits, judgments, losses, or expenses which might arise from or out of, or relate directly or indirectly to, my child's participation in the Program. This includes, but is not limited to, any medical care, whether emergency or otherwise, required which arises out of an accident or injury incurred by me or contraction of COVID-19 while participating in the Program.
E-Signature
This form uses e-Signature to accept your approval of, and agreement to, the forms described above and in detail on the preceding pages, in relation to the student named below. 

Please click "e-Signature" to go to the final page and sign the document.

PLEASE NOTE: After you sign the document, you will be sent a VERIFICATION email.  You MUST click the link in that email to complete the e-Signature process!