Little Panthers Program
Parents,
Here is the opportunity to enroll your student in daily activities before and after school.  We will be available 6:00-8:00 A.M. every morning and every day after school until 6:00 P.M.  You must let your child’s teacher, the office, or Little Panthers staff know each week what days and hours you need them to be there.  If not, needed staff will not be on site!  You must pay by Friday of each week, unless otherwise arranged.  If school closes early for weather, we will be closed.  All paperwork must be completed before enrollment.     A light snack will be served each afternoon.  We will facilitate homework, play in the gym, go out on the playground, and have library and computer time.  The contact number for South Ridge is 345-6789.  If voicemail picks up, immediately dial our extension at 3323 to leave a message or to contact staff.  You may also call or text
Jill Fries at (218)730-3270 or Lenny Johnson at (218)343-8323 or email Little Panthers at southridgelittlepanthers@gmail.com.
 
I UNDERSTAND THAT I WILL BE CHARGED A $5 LATE FEE IF I DO NOT PAY ALL LITTLE PANTHERS FEES BY FRIDAY OF THE WEEK MY CHILD ATTENDS UNLESS I HAVE NOTIFIED THE LITTLE PANTHERS STAFF THAT I NEED ANOTHER PAYMENT ARRANGEMENT.    Signature:_________________________________________________________________________      Date:_________________________
                                                                 
Child’s Name ____________________________ Age ____ Grade ____ Birthday ________Teacher_________________
     
      Child Lives With: Mother____ Father ____ Other: (Specify) __________________________________
 
     
Fees (due each Friday to avoid the late fee of $5.00):
$2.00 per child for morning session
$5.00 for first child for afternoon session; each additional child is $4.00 for afternoon session.
 
Hours care is needed:
      Mornings:
      Monday: ______  Tuesday :______ Wednesday: ________ Thursday: ________ Friday: _________
 
      Afternoons:
      Monday: ______  Tuesday :______ Wednesday: ________ Thursday: ________ Friday: _________
 
If you pick up your child past the closing hour of 6:00 P.M., a $5.00 late fee will be added.
 
 
 
***Continued on back side***
                                 
Mother or Guardian’s name                                                                       Home phone
Address                                                                                             Work phone
City                                                                                                    Cell phone
Employed by                                                                                                Work hours
Email address
       
       
Father or Guardian’s name                                                                        Home phone
Address                                                                                             Work phone
City                                                                                                    Cell phone
Employed by                                                                                                Work hours
Email address
 
 
 
Current Health Problems: Child’s name                         
Allergies
        
Medical Conditions
 
 
            Emergency contacts and Persons authorized to take child (ren) from child care (other than parent):
            They will need to show valid proof of who they are.
 
Name                                                           Relationship to Child                                            Phone Number
1.
2.
3.
 
 
Persons who are NOT authorized to take child (ren) from child care:
Name                                                           Relationship to Child                                           Phone Number
1.
2.
3.
 
 I will come into the school to pick them up.
 
Community Education Release made by the undersigned members or participants of
        Class:     South Ridge Little Panthers  Program 
To St. Louis County Schools, Independent School District No. 2142, a Minnesota municipal corporation, for class held at
South Ridge on or during the period of the 2016-2017 school year.  I hereby and forever discharge and release St. Louis County Schools, its successors and assigns from all debts, claims, demands, damages, actions and causes of actions whatsoever which I may have or may hereafter have as a result of the use of the above mentioned facility by myself or my child.  I acknowledge that I am aware of the risks and hazards involved in the aforesaid activity. 
        In witness whereof, I, the undersigned, have executed this release on the day and year appearing after my signature.
 
 
 
   Parent/Legal Guardian Signature ___________________________________________ Date ________________