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ST. ANN CHILD CARE REGISTRATION Child’s Name:__________________________________________ Date Registered:_________________ Age: _______________________________Birthdate:_________________________________________ Parent(s) Names: ______________________________________________________________________ Address: ______________________________________________________________________________ City: __________________________________________ State: _______ Zip: ______________________ Email: ________________________________________________________________________________ Siblings and ages: _____________________________________________________________________ ______________________________________________________________________________________ What should we do if your child is crying, upset, etc: _______________________________________ ______________________________________________________________________________________
Date: ________________ Signature: ______________________________________________________ CHILD’S MEDICAL INFORMATION Allergies: _____________________________________________________________________________ Medications: __________________________________________________________________________ Chronic Conditions (e.g. epilepsy, diabetes): _______________________________________________ ______________________________________________________________________________________ Family Doctor: _______________________________________ Phone: __________________________ Emergency Contact: ______________________________________ Phone: ______________________ ARCHDIOCESE OF CINCINNATI PERMISSION, RELEASE AND MEDICAL POWER OF ATTORNEY
1. I, the lawful parent or guardian of (the “child”), release from all liability and indemnify and hold harmless the Archbishop of Cincinnati (“the Archbishop”), both individually and as trustee for the Archdiocese of Cincinnati and all parishes within the Archdiocese, and their officers, agents, representatives, volunteers, and employees of either the Archdiocese or any parish thereof (“agents”) from any and all liability, actions, causes of action, claims, judgments, cost or expenses, including attorney fees, known or unknown at this time, arising out of or in any way related to any injury or illness incurred by my child while participating in the activity. 2. I agree to instruct my child to cooperate with the Archbishop or his agents in charge of the activity. 3a. I appoint the Archbishop or his agents who are acting as leaders of the activity as my attorney in fact to act for me in my name and my behalf, in any way that I would act if I were personally present, with respect to the following matters if any injury, illness or medical emergency occurs during the activity: (i) To give any and all consents and authorizations to any physicians, dentist, hospital or other persons or institutions pertaining to any emergency medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our attorney shall deem necessary or appropriate for the best interest of the child. (ii) I understand that the agents of the Archbishop will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child. 3b. The powers and authority granted herein may be revoked by me by written notice delivered to the Archbishop or his agents who are then acting or who have previously acted hereunder. Without such written notice, this power of attorney shall not be affected by my disability, incapacity, or adjudicated incompetency. This power of attorney shall lapse automatically upon completion of the activity and the return of my child to the ending place. 4. I agree that the Archbishop or his agents may use my child’s portrait or photograph for editorial purposes and office functions, and hereby release the Archbishop and his agents from any liability resulting from such use. I have carefully read this statement, and my signature acknowledges that I fully understand the content and meaning. Parent Signature: ________________________________ Date: ____________________ CHILD CARE PARENT INFORMATION: SAC PACK Ministry’s purpose for providing child care during mass is so families can go to mass and be able to participate more fully in mass without the worry of looking after their children and making sure their children are not a distraction to others at mass. Child care service is available for children from the age of 6 months to kindergarten. In order for this to be a child care cooperative, Any family that participates in child care MUST also work child care on a rotating schedule. You will most likely be on the schedule at least three times per every four month scheduling period. In accordance with Archdiocesan and Parish regulations, ALL adult or parents participating in the child care program MUST have their fingerprints on file with St. Ann Church and MUST have taken the Child Protection Decree Workshop in order for their family to participate in the child care service (See Parish Rectory for further details). Each child attending the child care services will have a registration/emergency medical form on file. These will be kept in Child Care Service’s Cabinet. An attendance sheet listing the children present at child care, parent volunteers present, and any other volunteers present will be kept for each 9:30 Mass. This will be used for liability purposes and to build the schedule. A diagram of the church will be kept with the attendance sheet so parents can mark down what section of church they will be sitting in incase we might need to reach the parent.
INFORMATION WHEN YOU ARRIVE: The child care program is available for you beginning fifteen minutes before the 9:30 A.M. mass. Please come early enough to help your child get involved in an activity before you leave for mass. Each Time you leave your child with the care service, please: Pull your child’s folder with the name tag in it Put your child’s name tag on the child Sign in your child on the daily register sheet and indicate where you may be sitting in church in the case that we need to reach you. If your child is not toilet trained, please leave an extra diaper for emergency changes. Please label any items (i.e. diaper bags, toys, etc.) that belong to your child with his/her name. If your child is SICK, please do not bring him/her to child care. We want to keep the well kids well! Please pick up your child immediately after mass. POLICIES AND PROCEDURES for S.A.C. P.A.C.K. Ministry Child Care during Mass
i. The schedule will list when a volunteer is to work. ii. This schedule will also include a list of volunteers’ names and phone numbers. This is only to be used if you need to find a substitute for yourself due to illness in the family.
i. FIRST AND FORMOST, take care of the injury in the most calm and organized manor. ii. Second, filling out an “Accident Form” iii. Immediately getting the parent(s) from church if it is a severe case iv. copy the “Accident Form” to give to parent(s) and keep the original form on file with the parish (use copy machine in DRE office or parish office)
i. LARGE Legos, No Mess coloring books and supplies, blocks, dolls and supplies, videos, some craft materials, board books, Little People toys, etc.
i. Changing pad, wipes, tissues, labels or masking tape for name tags, First Aid kit, Swiffer unit to clean floors, etc. Quarterly we will be asking families to donate cleaning supplies to help in the sanitizing process of all the toys and equipment. Parents are not required to donate. VOLUNTEER RESPONSIBILITY LIST
· All volunteers must arrive 20-30 minutes before the start of mass to set up the room for children to arrive. · Setting up the room: o Get the grounds supervisor or retrieve the key from the sacristy to unlock the Child Care Cabinet or call the Child Care Coordinators to come unlock the cabinet. o Pull out the File Bin that contains all of the information on each child that can attend child care. o Pull out the sign-in binder and have it ready for each parent to sign in their child/children. Have the diagram of the church laying out as well so parents know what to put down as to where they will be sitting at mass. o Make the Sanitizing solution so you are ready to clean all the toys and equipment at the end of mass. Add 1 oz. of Clorox Bleach to the spray bottle and fill the rest of the bottle with water. o If you are planning on showing a video, make sure that there is a television in the room and have it ready to show the movie/video. ALL VIDEOS/MOVIES MUST BE APPROVED BY THE CHILD CARE COORDINATOR BEFORE IT MAY BE USED DURING CHILD CARE MASS TIMES. Please do make sure that the children keep off and away from the television if it is on a cart. o Set up a changing diaper area so you are ready for emergencies. o If you plan on doing a craft with the children, please first make sure you have enough volunteers to help make it a successful craft time. ALL CUTTING MUST BE DONE BY AN ADULT VOLUNTEER! · What to do during mass time: o Allow the children to play with any of the toys in the cabinet. o Crayons, markers, paper, coloring books, etc. must have an adult supervising to prevent any children from eating the materials. o Change diapers only when needed. o Adult Volunteers may only take potty training or trained kids to the potty as needed. o Two Adults must be present at all times in the child care room. If an emergency arises, then one volunteer may leave to get help or a parent. o Due to children with food allergies, NO FOOD OR DRINK MAY BE CONSUMED DURING CHILD CARE, UNLESS SPECIAL PERMISSION HAS BEEN GRANTED BY ALL PARENTS AND BY THE CHILD CARE COORDINATORS! Water cups and/or bottles are permitted during child care. · Clean up time: o Please encourage all the children to start cleaning up the child care room when mass has ended or five minutes before it has ended. o All toys and equipment used during your child care session MUST be SANITIZED using a Clorox/Water Mixture made during the set up time. Spray the items with the mixture and allow the items to sit out to dry while you finish cleaning the rest of the room. o Make sure everything ends up back in the Child Care Cabinet in a neat and orderly fashion so the next group of volunteers won’t have any trouble finding everything. o If we are running out of any consumable items, please contact the Child Care Coordinators so that they can make arrangements to replenish the supplies needed. o Do not put away the File Box and sign in binder until all children have been signed out and picked up. o If any emergencies occurred, please make sure that the Accident Forms are filled out and a copy has been given to the parent(s). The parish copy is to be kept in the “Accident Form” file folder in the File Box. o Wipe down any tables that were used for crafts, diaper changing, etc. with sanitizing wipes that are kept in the top of the cabinet. o BEFORE LOCKING THE CABINET, go through the entire child care room to make sure that all of our supplies, toys, etc have been packed away. o Lock the cabinet and then you may leave the facility.
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