Beyond the Bell will open Monday, November 13 after school. Hours of operation will be Mon-Fri from after school until 6 p.m. and full days when students are not in attendance (8:30 a.m. – 4:30 p.m.). The program will not operate on holidays.
Beyond the Bell will be staffed with professionals and volunteers to run a variety of activities including outdoor activities, sports, crafts and art projects, community service opportunities, homework help and more! The program is FREE! A snack will be provided after school as well.
Filling out this enrollment form is required for attendance. Enrolling in the program does not mean that the student must come every day. Once the enrollment form is on file, the student is free to attend as many or as few days as they would like.
More information can be found on our website: www.healthdept.org
I understand that the purpose of these surveys and interviews is to document the impact of the Teen R.E.A.C.H. program on its participants, and to identify areas for improvement. I also understand that this information will remain private, and that only my child’s site director and assigned research assistants will be able to look at his/her responses.I understand that my child’s responses will be automatically grouped together with the responses of other Teen R.E.A.C.H. sites for any public presentations of their finding, and that my child will not be individually linked to his/her responses. In addition, I understand that I can take back my permission at any time, and that my permission automatically stops when the child leaves the Teen R.E.A.C.H. program.
We are seeking your permission to share information about the participant of enrollment and case-management purposes. This information includes the participant’s participation in any of the programs listed above. Based on the information, we may determine that the participant could benefit from other state-funded programs. We will also use the information in order to provide and pay for services for which the participant is enrolling, and to refer the participant for other necessary services.
We protect personal information we collect about the participant by maintaining physical, electronic and procedural safeguards. Program participation information will be shared only with authorized staff with a direct need to know about the participant. Information may also be released as necessary for participation authorization, and for programs audit and evaluation purposes. Necessary information, without any participant’s name, will also be sent to Federal and/or State agencies that fund the program.
By signing this Consent form, you agree to allow the information as described in the Consent to be used by this agency/clinic as described in the Consent. The person(s) receiving this information has(ve) a legal and ethical duty to keep the information confidential and private and not release it to anyone else except as described in the Consent, without your written permission, unless the law allows it.
I hereby authorize Clay County Health Department (eCornerstone site) to compare data already entered in the computer system regarding any other of the above programs that the participant my have participated in, with data about the participant collected during this enrollment/registration process, and to release data as necessary to provide the service requested and the referrals necessary.
This consent covers all the medical, social and financial information about the participant, including participant background and demographic information; health visit information; medical and developmental history; prenatal birth, and postpartum data; infant/child visit data; immunization records; participant risk and protective factors; problems or factors that prevent the participant from receiving proper medical care; appointments made and services received; goals and care plan; WIC food packages; program information; information required by the federal Maternal and Child Health Block Grant Program; Youth Programs; and Early Intervention Program, but only as relevant to the service being provided and as necessary to accomplish the above purposes.
This consent does not cover information about the diagnosis of treatment for mental health, AIDS, HIV, sexually transmittable diseases, alcoholism, and drug abuse which will not be released to other programs pursuant to this consent.
---Internet Safety/Cyberbullying ---Bullying---“Sexting” and other cell phone issues --- Inappropriate Touch Awareness/Sexual Abuse__Drugs/Alcohol/Tobacco
The hope is that speaking openly and honestly with the youth about some of these issues will equip them with the skills they need in order to make good decisions. The youth will also learn how to get help for themselves and others if they are ever faced with a difficult situation.
North Clay Elementary/Junior High - CEFS bus will pick up students after school.
Clay City - Health Department van will pick up students after school (pending number of enrollments).
Flora Schools will provide bussing from the Flora Elementary School and Flora Junior High after school.
Return transportation is NOT available at this time. Students must be picked up no later than 6:00 p.m. on school days and 4:30 p.m. on non-attendance days.
In cases of inclement weather or dangerous driving conditions, the health department van may not be transporting youth. Parents should listen to WNOI for any announcements.
Youth are expected to be on their best behavior while riding the buses or the van. Poor behavior may result in a suspension from transportation services.