Rainbows program

                                                                                                                               Sept. 10, 2012

Dear Parents,

            When something significant happens in a family, the entire family is affected. Things like death, divorce, or other types of losses have a profound effect on children, as well as grown-ups. Everyone grieves. Sometimes, because of their age or developmental level, children find it difficult to verbalize their feelings of grief.

            Three years ago, a K-8^th grade program called “Rainbows” was started to help children deal with these losses.  The program will be held at Kalona Elementary School after school hours for grades K-6 and the Middle School for 7^th and 8^th graders during lunchtime. We have caring, well-trained adults who will be sensitive to your child’s needs while they work on helping your child put their feelings into words, build a stronger self-esteem, and accept the changes taking place in the family. Children in “Rainbows’ will be grouped in small groups of similar aged peers. K-6^th graders will meet on Thursdays starting Sept. 27 from 3:45-4:30 pm. There is no fee or charge to join “Rainbows”.  Transportation home after the meetings is the parents responsibility but if you need help with this please call Kelly Galiher at 319-863-3079 (cell). If you are interested in your child(ren) joining “Rainbows” please fill out the form below and the emergency contact form attached to this and return both to your child’s school by Sept. 21, 2012.

             For more information about the program visit www.rainbows.org or contact Janet Ferry at 319-325-2178 or e-mail jferry@kctc.net. You may also contact Nora Kehoe at any of the elementary schools or e-mail nkehoe@mid-prairie.k12.ia.us with questions or concerns.

Child(ren)’s Name(s): _______________________________________________________

Age(s)/Grade(s): _____________________________________________________________

Address: _______________________________________________________________________

City: ____________________________ Phone: _______________________________________

Parent Signature: ______________________________________________________________

Please check for your child(ren):

                        (  ) I have experienced the death of __________________

                        (  ) My parents are divorced or going through a divorce.

                        (  ) My loss is _______________________________ (please explain).

RAINBOWS PARTICIPANTS EMERGENCY INFORMATION FORM

(Please print)

Participant’s Name:__________________________________________________________

Nickname:  _____________________________________          Age ____________________

Address _______________________________________________________________________

City/State/Zip ________________________________________________________________

Home Phone __________________________________________________________________

Work Phone _________________________________ Cell ____________________________

Parents/Guardians Names __________________________________________________

Is address same as above?       Yes    No

If no,  please provide address________________________________________________

Person we can call in case of an emergency:

Name ___________________________________________________________________________

Relationship to child __________________________________________________________

Phone numbers  _______________________________________________________________

Allergies or medical information regarding your child we should be aware of? _______________________________________________________________________

___________________________________________________________________________________

Other information you would like us to know? _____________________________

___________________________________________________________________________________

Who has permission to pick up your child? _________________________________

Relationship to child __________________________________________________________

Parent/Guardian Signature _______________________________ Date _____________