PUSD/Community COVID Child Care Coverage Application
Please fill out a separate application for each child who wishes to enroll.

Per Executive Order of the State of Arizona, during distance learning when schools are closed to in-person learning due to high risk of COVID transmission, if parents/guardians are unable to provide an atmosphere where their child can “safely engage in productive learning,” the district must provide such a space. When schools are not operating in-person, it is to mitigate the spread of COVID-19 due to high risk levels. This on-campus child care program is for currently enrolled students who have no other option or have needs that cannot be met at home or through distance learning.

This application is the first step for a student to sign up for COVID Child Care Coverage. Once you have submitted this application, and have emailed the attached forms to sarah.torres@prescottschools.com, you will be contacted at the phone number provided in your application within four business days. The maximum of four business days will be needed to ensure that enrollment numbers are proportionate with staffing, health and safety planning, and other logistics.  

Face coverings will be required for all adults and students over age 5. Students must follow all health and safety, as well as physical distancing guidelines. Temperatures of students will be taken daily at the child care facility if equipment and staff are available to provide this service. If students exhibit illness or COVID-19 symptoms, parents will be contacted for immediate pick-up.

Please complete/submit the application below.

Please email the following documents to sarah.torres@prescottschools.com, once you have completed and signed.

1.  COVID-19 Waiver, Release and Assumption of Risk Form:

https://docs.google.com/document/d/11PdB0YoIehu6T7HA6kQhuGUFZL8txUmSnvrskTzwbbw/edit?usp=sharing

2.  Bus Rider Form for COVID-19 Child Care form (if your student requires transportation):

https://docs.google.com/document/d/1kRwX5XFgjAuZ4vtyhSA6pn1wlLfrvPaYzbEFVaeSiuU/edit?usp=sharing

3.  PUSD Emergency Medical Consent Form:

https://docs.google.com/document/d/1vcrEO6mimys5dXrhhRX7HyZfAmCPuJLY6Qfh7qy_8t0/edit?usp=sharing
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Student Name: *
Parent/Guardian Name *
PUSD School of enrollment: *
Grade: *
Emergency Contact Name: *
Emergency Contact Phone Number: *
Best Phone for Questions or Communication (if different from Emergency):
Check below if it applies to your child
Would your student need Meals provided by our Food and Nutrition Department? *
Required
All meals will be charged according to your students meal status.
Breakfast:                                Lunch:
F = $0.00                                 F = $0.00
R = $.30                                   R = $.40
P = $1.50                                 K-6th $2.75
                                                 7th-12th $3.00
Please explain the reason that your child needs PUSD COVID Child Care Coverage *
Program Options
Please check your preferred location below (check only one) Qualifying students will be placed based on available space with physical distancing considered for placement.
The Boys and Girls' Club - Grades K-8, 8:00am to 3:00pm. The Boys and Girls Club will continue great programming for kids with an addition of distance learning support for school at their Prescott site.  They will also work with PUSD staff to offer a similar model at Mile High Middle School, using chromebooks and a variety of other student spaces on the campus.
Community Nature Center @ Granite Mountain (City of Prescott, AZ Serve, GEM Environmental) - Grades K-6, 8:00am to 3:00pm - This location will offer distance learning support both indoors and outdoors. The Granite mountain campus is next door to the City of Prescott’s Community Nature Center. Both areas offer wifi for distance learning space.  Environmental curriculum will be provided intermittently with time as an academic supplement as well as a break from digital learning.
During HYBRID Learning, what days will your child need to be in the COVID Childcare program? *
Other Local Options (Contact the provider directly)
Discovery Gardens Preschool:  https://www.prescottschools.com/dghome 

The YMCA:  https://prescottymca.org/child-care     

Boys and Girls Club:  http://www.bgccaz.org/ 

The Launch Pad:  https://thelaunchpadteencenter.org/
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