​Child's First Name:  

Child's Last Name:    Sex:

Address, City, Zip:  

Child's Birthday:        Age:

Enrolled School & District (2020-2021 School Year):        Grade: 

IF YOUR CHILD HAS AN INDIVIDUALIZED EDUCATION PROGRAM (IEP) WITH YOUR SCHOOL, PLEASE CONTACT DANIELLE OR LUKE FOR MORE INFORMATION.

Mother's Name:      Address if different than child: 

Cell Phone:                                          Work Phone: 

Name of Employment:   

Address of Employment: 

Father's Name:        Address if different than child: 

Cell Phone:                                           Work Phone:

Name of Employment:    

Address of Employment: 

Special instructions for trying to reach parents during camp hours:

PHILOSOPHY

The health and safety of our families and staff is our greatest concern and we do not take this manner lightly.  We also realize this a very uncertain and stressful time for everyone as the school year approaches.  We feel we can provide a unique opportunity to our community in our large, state of the art facility.  The facility allows children the ability to spread out when they are not in their learning pods.  Impact Kids Club hybrid learning goal is to meet the needs of all children during this stressful time.  We will offer a combination of remote learning with a mentor, physical activity, introduction to a variety of sports, social emotional health and much more.  We have an amazing and highly qualified staff to assist kids in all learning and activities throughout the day.  Impact Kids Club will be following all guidance from state and local officials as well as the Health Department.  Our ultimate goal is to remain open, provide services in the safest manner possible and make our families feel comfortable during that process.  Outlined below is our plan and protocols that will be implemented for reopening.  We will be operating following all of the guidelines provided to us from our Colorado child care licensing specialists along with state and local officials and CDPHE.  

Per those guidelines, our childcare facility will be:

• Maintaining a less than 1:15 ratio in all licensed areas of the facility while practicing social distancing.

• Limiting the interaction of groups and staff when possible.  Each staff member will remain with their group of children throughout the day.

• Utilizing a curbside check-in and checkout process, which will limit the adult contact with others and also with shared supplies (pens, door handles, etc.)

• All temperatures will be taken upon arrival and before allowed entry into the childcare setting (staff and children). 100.4 degrees is considered a fever per the CDPHE and will not be allowed into the building.

• All staff or volunteers over the age of 11 will be required to wear a mask or face covering while in the building, per state mandate. 

• Sanitation and proper disinfecting will be performed during the day of shared items and surfaces.

• Professional cleaning and disinfecting will be performed at the end of each day on all shared items and surfaces.

• Any child or staff member showing signs or symptoms of sickness while at the facility will be quarantined and sent home as soon as a parent/guardian is able to pick them up.

• If any person who has been in the facility tests positive for Covid19, it will be reported to Boulder County Health and they will advise for the next steps to be taken.

• Daily records will be kept in the childcare noting who children and staff may have come in contact with.

• Proper and frequent handwashing will be implemented and supervised when possible.  

• Groups will stay together during lunchtime and will maintain proper distancing

AGE REQUIREMENTS

Children participating in Kids Club Hybrid Learning must be enrolled in school K-8 grade during the 2020-2021 school year. NO EXCEPTIONS.  We will follow each child’s school 

DATES AND HOURS OF OPERATION

Kids Club Hybrid learning will operate from August 24th and will continue until school is 100% in person learning.

Hybrid learning hours are: 

Monday - Friday 8:00 a.m - 3:00 p.m.  

This option has flexible scheduling, choose your days.

Impact Kids Club Afterschool program hours are:

Monday - Friday from 3:00 pm - 6:00pm 

Membership options only (1-2 days or 3-5 days options)

Check-in time will be from 8:00am -9:00am (Please do not arrive before 7:45, there will be no supervision before this time for your child.) If you need to arrive after 9:00 a.m, you need to make special arrangements, the night before, with Danielle Reed danielle@myimpactsports.com.  

Children must be picked up by the designated time or your card on file will be charged $5.00, per every 5 minutes past pickup time. If the Camper is not picked up within 10 minutes of the designated pickup time, the director will notify everyone on the emergency contact list. If the director has not received a call back within 30 minutes an additional call will be made to all emergency contacts to pick up the child.  If a child has not been picked up after 1 hour of the designated pickup time, the director will contact Superior Police department.  This will be reported to the Social worker on duty to file an abandoned child report.  

SIGN IN /SIGN OUT PROCEDURES

We have adopted a curbside dropoff and pickup for all kids.  This will minimize the exposure for our staff during these times.  Staff will meet children at the curb, take the child's temperature and check for any symptoms.   The individual who is picking the child up for the day, must present a photo ID.  Children will not under any circumstance be released without showing a proper and valid identification.  Children will only be released to individuals listed on the Emergency Info Card. If an individual not listed on your child’s card is going to pick them up, it will be allowed if in writing by a parent/guardian and received in the morning by the Director or Assistant Director.  Impact staff reserves the right to hold a child if the responsible parent or the third party has not provided proper notification of release or does not provide adequate photo identification.

REGISTRATION, FEES AND CANCELLATIONS

Registration can be done online at www.myimpactsports.com.  Fees will depend on how many weeks/days/months children are registered for.  All fees may be found online.  

Parents must sign all appropriate waivers, submit health records and emergency forms provided by Impact Sports and Impact Kids Club before registration is considered complete.  

YOUR CHILD MAY NOT ATTEND OUR  Hybrid Learning school  UNTIL ALL FORMS ARE COMPLETED!

You can access fees via the website.   Payment plans are available upon request.  Please email Danielle Reed for more information.  

********IMPORTANT INFORMATION*******

Due to popularity and limited spots,  NO REFUNDS will be given AFTER PURCHASE  Fees will not be prorated or refunded for children missing camp due to vacations, illness or any other reason.

• In the event a child becomes ill, injured, or does not possess the necessary skills to participate in camp, a pro-rated refund may be given upon request.  Proper documentation may be requested (doctor’s note).

•  

• Non-payment, late payments or return payments may result in permanent dismissal of child from camp

Tentative Daily schedule:

TRACKING STUDENTS

Children will be split up into groups based upon grade level.  This will allow us to provide children with the help they need during hybrid learning times.  Our staff will  perform several head counting, face to name checks, roll calls and communication using walkie-talkies with other counselors and the director throughout the day.  Your child’s safety is our number one concern!

VISITORS

All visitors will be asked to sign the visitor log indicating name, address, phone number, date, time, provide identification and list reason for visit.

LOST CHILD ON-SITE 

In the event that a child becomes missing during our care, all available staff will immediately begin a search. We will determine where and when the child was last seen.  If he or she is not found within 10 minutes, the local police department will be notified as well as the parent/guardian. When the police arrive, the search and rescue will be turned over entirely to them.

EMERGENCY PROCEDURES

All staff are CPR/First Aid certified.  In the event of an emergency, staff will respond to the best of their ability. Every effort will be made to provide appropriate care.  

If a child is injured, first aid will be administered and staff will let the parent/guardian know if their child needs to be picked up.  In the case of a severe injury, 911 will be called and parents will be notified that their child was transported by emergency vehicle to the hospital. Minor injuries will be reported to the parent/guardian when they arrive to pick-up their child.  An Impact Staff member will fill out a complete incident report.

Please be considerate to other families and if your child is demonstrating any sign or symptoms of illness, please keep your child at home. If your child is contagious, allow the recommended time pass by a physician before they return.   If your child becomes ill, a parent/guardian will be notified to come and pick them up. Until a parent arrives, they will be separated from other children and provided assistance from a staff member.  Any contagious illnesses will be communicated to parents via email and the identity of the child will be kept confidential.

As required by the Colorado Department of Human Services Rules Regulating Child Care Centers, certain illnesses and accidents requiring medical treatment will be reported to the State.

NATURAL DISASTERS

In the event of a natural disaster such as severe weather, fire or flood or a lockdown, the safety of our campers and staff is our number one priority!  All staff members are properly trained on all of the above safety and evacuation procedures. Drills are held to familiarize staff and children on those specific emergencies. Staff will also be trained on the City’s lightning procedures.  Remain in a safe area for 30 minutes after the last lightning strike was heard or seen, before resuming outdoor activities. 

EVACUATION PLAN

In the event of an evacuation of the Sports Stable; a fire, earthquake, bomb threat or other unforeseen emergencies, we will evacuate to the north of the facility.  Depending on circumstances, parents may be notified to pick up their children.  Modified evacuation plans may be created depending on the child’s ability.

MOVIES/VIRTUAL GAMES

Movies will be shown occasionally throughout the semester.  Movies be rated G or PG.  Within the Sport Stable, there is an arcade and Fairways golf simulators which may be utilized as well.  The simulators can be used to hit golf balls on various virtual courses. Please inform Impact staff if you prefer that your child does not watch a movie or play in the golf simulators.   During this time, we will find an alternative activity for those children.  The activities may include reading quietly, coloring, crafting, board games or another quiet activity.  

SERVICES OFFERED FOR CHILDREN WITH SPECIAL NEEDS

Impact Kids Club does not discriminate on the basis of race, color, national origin, sex, or disability.  We are dedicated to supporting the Americans with Disabilities Act.  We are not required to provide individuals with disabilities personal devices.   Any personal nature services including assistance in eating, toileting, or dressing is not provided by our staff. If your child is unable to perform activities of personal care, you may provide a personal care assistant at your own cost. (35.135 Personal devices and services)

Before enrollment, we encourage you to talk with our Director about your child’s needs and we can tell you more about our setting and structure to see if it would be a good fit.  Some things to consider before enrollment into camp; camp will be highly stimulating, loud and kids will need to be in control with minimal intervention or prompting.  The day will include many transitions in a structured and semi-structured environment.  The campers will be participating in various sports and remain active throughout the day.  

RESTRAINING ORDERS

If there is a restraining order which prohibits someone from having contact with your child, written documentation needs to be provided and notification if any changes occur.

CHILDREN'S BELONGINGS AND STORAGE

Children's belongings will not be kept in a locked area.  They will each be provided with a basket to keep their belongings in throughout the day.  We will do our best to help each camper keep track of their belongings but we are not responsible for lost, stolen, damaged or misplaced items.  All belongings will need to be taken home daily.  

ITEMS TO BRING TO HYBRID SCHOOLING:

PLEASE LABEL ALL BELONGINGS AND ENSURE THEY CAN FIT INTO A BACKPACK AND CAN BE CARRIED BY THE CHILD

Children need to bring:

1. Laptop, chromebook or any device that your child will be using for remote learning.

2. A lunch and 2 snacks (microwave or refrigeration are not available, please plan accordingly).

3. A leak-proof water bottle.

4. Please ensure that your child is in appropriate clothing.  Weather in Colorado is very unpredictable; please plan for any weather that may arise.  

5.  

ITEMS NOT TO BRING TO KIDS CLUB

Note: Impact is not responsible for any items brought from home

1. Money,

2. Valuables of any type besides learning devices.

3. NO weapons of any type: toy weapons, pocket knives etc.  

4. Cell phones must remain in the child’s backpack throughout the day and may not be taken out during camp hours.  

COMMUNICATION

Communication is going to play a key role in the success of your child at summer camp.  Camp staff is always open to questions or concerns.  The best way to communicate with staff will be at the beginning of camp each day.  We ask that these conversations are brief and if parents would like to set up a time for a longer conversation, please call or email Danielle Reed.   Weekly calendars will have a listing of on and off site activities.  A completed calendar with all field trips will be posted by May 15, 2017. Modifications of the calendar and activities may be necessary due to unexpected events such as weather. We will do our best to communicate with parents all changes and updates that may occur during summer camp using email.

We have our state license and copy of inspection records available for review in the Director of Impact Sports office.

If you need to file a complaint, please do one of the following:

1. Speak to the appropriate level staff member/members

2. Call 303-866-5958

3. Write a description of the complaint that includes: your name, telephone number and mailing address to:

Colorado Department of Human Services Division of Early Care and Learning,

Attention Complaint Intake

1575 Sherman Street, First Floor, Denver, CO 80203-171

IMPORTANT CONTACT INFORMATION:

Danielle Reed,  Director                                (720) 620-2049      Email:danielle@myimpactsports.com                                   

Luke Goodgion, Assistant Director                                                 Email: luke@myimpactsports.com

Rylan Reed, Director of Operations             (303) 467-2288      Email: rylan@myimpactsports.com

REPORTING CHILD ABUSE

As a licensed child care facility, each staff member is required to read and sign a statement clearly defining child abuse and neglect pursuant to state law and outlining the staff member’s personal responsibility to report all incidents of suspected child abuse or neglect according to state law.

All staff receives training in the area of:

Child abuse and neglect/Mandatory reporting, FEMA emergency prepardness, Standard Precautions, CPR/FIRTS AID, and 15 hours facility training,.

Child abuse is: Physical abuse, emotional abuse, sexual abuse and neglect

As a licensed childcare facility, Impact will make every effort to provide a safe and healthy environment for your child. If you should suspect child abuse at our facility, a report of suspected child abuse must be made to the County Department of Social Services, Police Department, or other law enforcement agency in the community or county in which the facility is located.  

Law requires child care staff to report any suspicion of abuse or neglect. A report of suspected child abuse or neglect must be made immediately.  Once the report is made, a Social Service worker will determine if there is a need for an investigation.  

MEDICATION (Strictly enforced)

An Impact staff member who has received special training in medication administration will be on site at all times.   Staff cannot administer any medications, prescription or over-the-counter, without the following:  The same paperwork as schools do.  If you fail to bring the correct information/paperwork or medications, your child will not be allowed to attend Kids Club on that day.  See below for a list of items need:

1. Written authorization from the health care provider, signed by DR and parent or guardian

2. Medication in the original labeled container with child’s name on it 

3. Instructions from the health care provider with;

-reason for medication

-any information the facility may need to know regarding the medication

-specific time of administration

-length of time the medication needs to be given

If your child is taking any type of medication, and they require special medical attention, or if they take any medications on a regular basis during the day, the parent/guardian will need to meet with the supervisor prior to the child’s start date.  A Health Care Plan specific to your child will be put into place. The proper paperwork needs to be completed by the parent/guardian or they will be asked to return to Impact to administer medication themselves.   Parents may consider checking with their healthcare provider to see if a dosage schedule can be arranged that does not involve the hours the child is at day camp.  It is the parent’s responsibility to supply all medications and supplies to camp. Children are not permitted to carry any medications, prescription or over-the-counter at camp.

POSITIVE ENVIRONMENT

At Impact, our goal for hybrid learning is to provide a fun and safe environment while helping guide students through their online learning curriculum.  When the children aren’t learning, we will keep them active and provide a healthy social environment. We feel strongly that during these uncertain times, mental health is very important.  We believe a positive relationship between learning mentors, counselors, kids, coaches and families will encourage a learning environment filled with good communication, mutual respect, problem-solving strategies and positive social interactions.   We encourage kids to talk to any staff member with any concerns, worries or problems, they may, throughout their time at KIds Club.  We want to emphasize positive peer and social interaction by utilizing hands on mentors and inclusion for all children.  At Impact, we also want to create an atmosphere which utilizes positive reinforcement, redirection, and conflict resolution.  We will do our best to resolve all issues when they are presented in a fair and consistent manner.  We understand that every child is unique and what “works” for one child may not for another.  Parents are obligated to release any information/disorders about their child which may affect their ability to execute day to day learning and activities.  We will work with parents to understand and determine what interventions work best for their child to have a positive experience at The Club.   Failure to disclose appropriate information may result in dismissal without refund.

BEHAVIOR INTERVENTIONS

Serious and continuous behavioral problems may result in; talks with the child, talks with the parent, written reports, meeting with the child and parent implementing  a behavioral contract, and dismissal as a last resort.  If a child receives two written reports in a week they will be dismissed from the session and will not be able to attend future sessions until a meeting has taken place with the Director, Parent/guardian and child.  

Extreme incidents may require immediate dismissal without prior notice.  Refunds will not be issued for children dismissed due to behavior. Actions that will not be tolerated at Impact Summer Camp and will require the child be picked up immediately.

1. Behavior that is continuously disruptive

2. Behavior that poses a threat to him/herself or others (hitting or fighting of any kind)

3. Destruction of property

4. Leaving without permission

5. Failure to respond to staff or camp policies

6. Inappropriate touching

OUR IMPACT STAFF

Our Impact Staff is an amazing and diverse group of individuals made up of Teachers, college students, graduating high school students and highly qualified sports instructors. Each staff member goes through an interview process, adequate training, and CPR and First Aid to make certain that they are a good fit for this unique hybrid program at Impact.  Not only will your child be interacting with talented and energetic counselors, learning mentors and aides, but they will also be spending time with Impact’s Sports Training Staff.  These trainers will be introducing a variety of sports along with the fitness based program and activities your child  will receive in between their learning curriculum.  In order to ensure the safety of all campers, each staff member has been fingerprinted which provides us with an extensive background check.  They have also met all licensing qualifications for the position they hold.  We will maintain a 1:10 or 1:15 ratio at all times so we can provide a high level of mentoring and supervision.   No adult should be alone with a child, one on one and out of the public eye.  If you have any questions or concerns with a staff member at Impact, please see the Director.  

I have read, understand and agree to the policies and procedures in the Summer Day Camp Handbook.

(Please initial):

AGREEMENT CANCELLATION/REFUND POLICY:

• IThe only time a refund will be given is in the event a child becomes injured, or does not possess the necessary skills to participate in camp, a pro-rated refund may be given upon request.  Proper documentation (Doctor's note) will be needed to process 

• Non-payment, late payments or return payments may result in permanent dismissal of child from camp

(Please initial):

RETENTION OF RIGHTS: I understand and acknowledge that Impact Sports Performance owns and retains all video and photographic rights in connection with the participant's involvement in all programs, camps, and activities conducted by Impact Sports Performance, LLC. 

(Please initial):

COVID-19 Disclaimer

SPORT STABLE AT SUPERIOR

VISITOR/PARTICIPANT RELEASE OF LIABILITY, 

WAIVER OF CLAIMS, ASSUMPTION OF RISKS & INDEMNITY AGREEMENT

-- 

***WARNING: PLEASE READ CAREFULLY BEFORE SIGNING! THIS IS A RELEASE OF LIABILITY & WAIVER OF CERTAIN LEGAL RIGHTS INCLUDING 

THE RIGHT TO SUE OR CLAIM COMPENSATION***

In consideration of being allowed to enter the Sports Stable at Superior, use any of the facilities, participate in any program, related events and/or activities held at Sport Stable at Superior, I, the undersigned, for myself and any minor children listed below (for whom I have the capacity to contract), represent, acknowledge, appreciate, and agree that:

1. The risk of injury from the presence, use and engagement in activities and programs at the Sport Stable at Superior is significant, including the potential for permanent paralysis and death, and while particular rules, policies, equipment, and personal discipline may reduce this risk, the risk of serious injury or death does exist; and

2. In addition to these risks, due to the high level of threat to my health and well-being (and that of any of my minor children) arising from the  Coronavirus (COVID-19) pandemic, any such minor children and I are at risk of contracting this virus while at the Sport Stable at Superior; and

3. If I, or the minor children, do contract COVID-19, it may result in serious illness or death and that others with whom I, or they, have contact are also at serious risk; and

4. I understand that despite the reasonable efforts of the Sport Stable at Superior to make sanitizing agents available, post signage directing visitors and employees, perform extra cleaning of its equipment and facilities, there can be no assurance that such precautions are sufficient or that they will prevent the spread of COVID-19 to persons who enter or use the facility; and 

5. The recommendations of the CDC and other health organizations is changing daily, and sometimes more frequently, and that it is my responsibility alone to follow the guidelines and recommendations of such health professionals as it related to my presence and use of the facilities at the Sport Stable at Superior; and

6. I represent that I, any persons in my household and any of my minor children: (a) are strictly abiding by the recommendations and orders of the CDC, federal, state, and local governments, (b) have no symptoms of respiratory or other illness, (c) have not been exposed to any to another person with such symptoms within the past 14 days, (d) have not traveled outside the United States in the last 14 days, and (e) have not had contact with any person who has, or is suspected to have, the COVID-19 virus; and I authorize a licensed medical care provider to carry out any emergency medical care which may be necessary and agree to be fully responsible for any associated costs.

7.  I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, for myself, and for any minor children, both known and unknown of entering the facility, using the equipment or participation in any activity or program at the Sport Stable at Superior, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my, and for any minor children, use of the facility and participation in any activities or programs; and,

8. I willingly agree to comply with the stated and customary terms and conditions for the use of the Sports Stable at Superior and participation in any activities or programs, including those special postings relating to extra precautions to be taken by me in light of the COVID-19 pandemic, and how they relate to use of the facility and participation in any activity or programs by me, and the minor children.  If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself and minor children from participation and bring such to the attention of the nearest Sport Stable at Superior employee immediately; and,

9. For safety and hygienic reasons, the minor children shall refrain from bringing their own toys to the Sports Stable at Superior. Disruptive or inappropriate behavior will not be tolerated. In these circumstances, the parent/legal guardian will be notified immediately. Children will be released ONLY to a person listed below as the relation or authorized person. Medications will not be administered by Sports Stable at Superior staff.

10. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin (including any minor children), HEREBY RELEASE, INDEMNIFY, AND AGREE TO HOLD HARMLESS THE SPORT STABLE AT SUPERIOR, their officers, managers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the activity or event (“Releasees”), WITH RESPECT TO ANY AND ALL LIABILITIES, CLAIMS, PENALTIES, LOSSES, OR EXPENSES (INCLUDING ATTORNEYS’ FEES), OF ANY KIND OR NATURE WHATSOEVER, WHETHER RELATED TO BODILY INJURY, PROPERTY DAMAGE OR ANY OTHER FORM OF INJURY OR LOSS TO MYSELF (AND TO ANY MINOR CHILDREN FOR WHOM I HAVE THE CAPACITY TO CONTRACT) WHETHER RELATED TO BODILY INJURY, DISABILITY, ILLNESS, DEATH, PROPERTY DAMAGE , or any other injury, loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law; and

11. The Sport Stable at Superior may use Cameras or Video Cameras in the Non-Private areas of the Arena. Pictures or Video Filming is used for production of events and to identify Security and Safety Concerns in the Facility. I, for myself, and the minor children for whom I have the capacity to contract, agree that the Sport Stable at Superior may use any Pictures or Audio/Visual recordings for Promotional, Advertising or Educational Purposes.

I acknowledge that I am also signing this Release on behalf of my minor child (children), that I am WAIVING CERTAIN RIGHTS ON BEHALF OF MY MINOR CHILD (CHILDREN) that my child (children) otherwise have, and that MY CHILD (CHILDREN) SHALL BE BOUND BY ALL THE TERMS OF THIS RELEASE. I understand that this Release will apply for each and every day my child (children) is present, uses or is engaged in activities or programs at the Sports Stable at Superior. 

I understand that this Release is a contract and, to the fullest extent permitted by law, shall be binding on me and my assignees, subrogees, distributors, heirs, next of kin, executors and personal representatives. If any part of this Release is deemed to be unenforceable, the remaining terms shall be an enforceable contract between the parties.

(Please initial):

Choose your favorite sport:

Choose one:

*Participant (must be 18 or older)Parent/Legal Guardian