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2019-2020 Out of School Time Registration (Olathe)

  1. JCPRD logo

  2. Did you participate in the 2018-19 OST Program in Olathe schools (i.e. Y-Care, Olathe P&R)?*

  3. Is your child eligible for Free or Reduced Lunch?*

    Verification letter from school district will need to be provided to receive reduced rates.

  4. Program Options*

  5. Days of Attendance*

    *Days must be consistent

  6. Eligible for 2nd Child Discount*

  7. SEPARATE ENROLLMENT FORM REQUIRED FOR EACH CHILD.

  8. JCPRD is committed to making reasonable accommodations as required by the Americans With Disabilities Act. Requests must be made two weeks or ten working days prior to the start of the program. Please indicate what accommodations are needed.

  9. For JCPRD Staff Only

  10. For JCPRD Staff Only

  11. Electronic Signature Agreement*

    JCPRD AUTHORIZATION FOR RECURRING PAYMENTS: I understand that I must call the JCPRD Registration office at the phone number listed below and provide my debit or credit card information to complete this authorization for recurring payments within two business days of receiving confirmation of my registration. Completion of this form will authorize regularly scheduled charges to your Visa, Mastercard, Discover, or bank account (via ACH) . Your account will be charged per the payment schedule provided by the JCPRD Registration Office. Proof of payment will be available to you through your CLASS registration account. The authority you give to charge your account will remain in effect until JCPRD Registration is notified in writing to terminate this authorization and a new account number is provided to complete your payment schedule, or until fees are paid in full and/or care is terminated. To grant authorization for recurring program payments, complete this form and return it with the remaining registration forms to registration@jocogov.org. For ACH payments, please submit a voided check with this form. I authorize JCPRD to charge my account for payment of the JCPRD Program for my child(ren) listed below. I agree to notify JCPRD in writing of any changes in my account information 15 days prior to the next due date of the charges and will not dispute merchant recurring billing with my credit card company, so long as the amount corresponds to the terms indicated in the payment schedule. If my account does not accept the scheduled charges, I am aware that I will be assessed a $30 reconciliation fee, with a maximum non-resolution period of 10 days at which time my child care will be terminated. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  12. Electronic Signature Agreement*

    JCPRD WAIVER STATEMENT: "The undersigned states that he/she understands that the Johnson County Park and Recreation District is not and shall not be responsible for or liable for any illness, or injury to person or damage to property resulting from the program in which the undersigned is enrolling or being enrolled or from his/her participating in said program, and the participant and the undersigned, if the participant is a minor or under other legal disability, hereby forever releases and holds harmless the said Johnson County Park and Recreation District, it’s employees, agents and representatives from any and all claims of any kind that the participant, or the undersigned or their respective heirs, executors, administrators, or assigns may have or claim to have resulting from participation in said program. NOTICE: By enrolling in this program you hereby acknowledge the Johnson County Park and Recreation District can and may photograph and/or video tape program participants and then use such images, without payment or any other consideration, for purposes of publicizing District parks, facilities, programs or services, or for any other lawful purpose. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  13. Electronic Signature Agreement*

    SCHOOL DISTRICT WAIVER: We, the undersigned, parents of (student named above), acknowledge that the Before and After School Care Program operated by Johnson County Park and Recreation District (“Park District”) is not a program operated or controlled by Olathe Unified School District No. 233, Johnson County, State of Kansas (the “School District”); that the School District is only a lessor of space and has no responsibility whatsoever for the administration or operation of the program, for the selection of any employees to operate the program by the provider thereof, or for any act or omission which may occur while any child is going to, participating in, or going from the program. We, further, acknowledge that the curriculum and/or activities that are part of the program have not been approved by the School District and will not be supervised by the School District. We agree that the School District shall not be liable for any act or failure to act on the part of the Park District, its agents or employees, and we do waive any liability of the School District with reference thereto and promise and agree to save, and hold the School District free and harmless from any and all loss, of any and all nature or kind whatsoever, as the same may relate to any injury suffered or damage sustained by our child(ren) participating in the program or by us.

  14. Leave This Blank:

  15. This field is not part of the form submission.