T-Zone

Attention Newport News and Surrounding Area Parents! Do you need help with supervision for your child during the work/school day? If your answer is “Yes,” then look no further!
Gethsemane Baptist Church, Newport News, is excited to offer you a safe, Covid-19 regulation day program to assist working parents who have young school age children. We are accepting students in grades K-6th into our Christ centered virtual learning space. If you are in need of this amazing family service, please complete the registration/application form on this page. The weekly fee is ONLY $100 PER WEEK ($25 a day). We will function Monday – Friday from 6:30 A.M. – 5:30 P.M. beginning on Monday, February 15, 2021!
REGISTRATION IS NOW OPEN!

T-Zone Registration Form

Step 1 of 7

Child Information
Child's Name:*
First Last
Child's Date of Birth:*
MM
DD
YYYY
Child's Age:*
Address:*
Street Address City State ZIP Code
Phone Number:*
School:*
Grade:*

Parent/Gaudian Information
Mother's Name:*
First Last
Place of Employment:*
Business Address:*
Street Address Address Line 2 City State ZIP Code
Business Phone:*
Work Hours:*
Email*
Father's Name:*
First Last
Place of Employment:*
Business Address:*
Street Address Address Line 2 City State ZIP Code
Business Phone:*
Work Hours:*
Email

Special Needs Information
Chronic Physical Problems/Pertinent Developmental Information:*
Special Accommodations Needed:*
Allergies/Intolerance to Food:*
Medication Taken:*

Emergency Contacts
Emergency Contact 1 Name:*
First Last
Emergency Contact 1 Address:*
Street Address Address Line 2 City State ZIP Code
Emergency Contact 1 Phone Number:*
Emergency Contact 2 Name:*
First Last
Emergency Contact 2 Address:*
Street Address Address Line 2 City State ZIP Code
Emergency Contact 2 Phone Number:*
Emergency Contact 3 Name:
First Last
Emergency Contact 3 Address:
Street Address Address Line 2 City State ZIP Code
Emergency Contact 3 Phone Number:
Pickup Authorization
Person(s) authorized to pick up child(ren):*
Person(s) NOT authorized to pick up child(ren):*

Agreements and Liability Waiver
Agreements*
By checking this box I agree to the following
1. Children with a temperature of 100 degrees Fahrenheit or greater will not be allowed to enter Gethsemane Baptist Church T-Zone Student Day Program.
2. Children that become ill during hours of operation must be picked up immediately and will not be allowed to return without a doctor’s note.
3. The parent/guardian authorizes Gethsemane Baptist Church T-Zone Student Day Program to obtain immediate medical care if any emergency occurs and the parent/guardian cannot be contacted.
4. The parent/guardian agrees to inform Gethsemane Baptist Church T-Zone Student Day Program, within 24 hours, or the next business day after any child or household member has developed a reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases which must be reported immediately.
5. The parent/guardian agrees to inform Gethsemane Baptist Church T-Zone Student Day Program, immediately if any child or household member test positive for Covid-19 or has encountered anyone who has tested positive for Covid-19, as defined by the Center for Disease Control and Prevention guidelines.
*Parent or guardian signature required upon drop off.
Liability Waiver*
By checking the box I agree to the following liability waiver.
I hereby consent to the registrant’s participation in Gethsemane Baptist Church T Zone Student Day Program. I voluntarily release and forever discharge the Gethsemane Baptist Church T Zone Student Day Program from all liability, claims, actions, or rights of action that is in any way related to the registrant’s participation in Gethsemane Baptist Church T Zone Student Day Program. I agree to indemnify and hold Gethsemane Baptist Church T Zone Student Day Program harmless from all costs or damages, including attorney fees, incurred in connection with the registrant’s participation in the program and program activities. I further agree not to sue, assert, or otherwise maintain any claim or cause of action against Gethsemane Baptist Church T Zone Student Day Program. In addition, I hereby consent to the registrant being filmed/photographed and give Gethsemane Baptist Church T Zone Student Day Program permission to use the film/photographs for any type of publication.

In addition, I understand that Gethsemane Baptist Church T Zone Student Day Program is a Faith Based Program. I consent to the registrant’s participation in religious training such as daily devotions, morning prayers, closing prayers, bible verses, etc.

In case of emergency, I understand every effort will be made to contact parents or guardians of registrants. However, if parents or guardians cannot be reached, all emergency contacts will be contacted. I give Gethsemane Baptist Church T Zone Student Day Program permission to act on my behalf in seeking and administering medical treatment for the program participant. I agree to release Gethsemane Baptist Church T Zone Student Day Program from any liability in acting on my behalf in this regard and rendering such medical assistance. I assume the risk and financial responsibility for any injury resulting from the registrant’s participation in all activities.”
*Parent or guardian signature required upon drop off.
The registration form was filled out by:*
First Last

Student Login Information
Student Name:*
First Last
School District:*
Teacher's Name(s):*
Prefix First Last
Teacher(s) Email:*
Grade:*
Student Email:*
Student Username:*
Password*
Zoom meeting ID:*
Zoom Passcode:*
Student Schedule
Classes and Class Times:*
List all classes and times including the child's lunch break.
Needs/Accomodations*

Gethsemane Baptist Church T-Zone Student Day Program Contract
Name of parent or legal guardian contracting for servicees:*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone:*
Work Phone:*
Cell Phone:*
Name and age of each child for whom services will be provided:*
Agreement to contract and applicable fees:*
By checking the box I agree to this contact and all applicable fees:
Payment in full for all children is due each Monday (or the next business day if the facility is closed) for that week's care. We reserve the right to refuse care to children whose parents or legal guardian's account is past due. Children left at our facility without our permission will be reported to the authorities as abandoned/neglected children.
Fees are $100 Registration and $100 Program Fee each week on a "use it or lose it" basis. No refunds or credits will be given.
If a payment check is returned or dishonored, a fee of $100.00 will be charged. Payment may be required in cash or other guaranteed funds if a check is returned or dishonored.
The facility will be closed on Saturday and Sunday of each week, and on federal holidays. Weekly fees are not prorated during weeks which include holiday closure(s) or inclement weather.
During family vacations and other extended absences from care, the parent or legal guardian may pay one-half of the usual weekly fees to reserve the child(ren)'s eligibility for care services upon their return. If this reservation fee is not paid during the absence, the facility may or may not accept the child(ren) back into care upon their return.
This agreement may be terminated by either party with two weeks' written notice to the other party.
*Parent or guardian signature required upon drop off.
The contract was filled out by:*
First Last

What are we doing to prioritize your health during the COVID-19 Pandemic? LEARN MORE HERE

What are we doing to prioritize your
health during the COVID-19 Pandemic?
LEARN MORE HERE

T-Zone Registration Form

Step 1 of 7

Child Information

Parent/Gaudian Information

Special Needs Information

Emergency Contacts

Pickup Authorization

Agreements and Liability Waiver

Student Login Information

Student Schedule

Gethsemane Baptist Church T-Zone Student Day Program Contract