The child listed above will only be released to his/her parents and the individuals listed below. Please inform us of any changes as we will not release a child to an individual that is not listed. Please include anyone that might pick them up from bus stops as well. Thank you!
To support your child's individual needs, your child's teacher will schedule a care plan meeting with you within the first few weeks of school, and write short-term goals to address several areas of your child's development. Below is a list of areas that are often a challenge for children on the autism spectrum, and skills which may be a target for development during the school year. This form can be used to brainstorm ideas prior to your child's care plan meeting.
I hereby give my permission for other individuals, parents, or guardians to observe treatment session(s) where my minor child would be participating. The intent is to provide the opportunity for a parent/guardian to observe their child in a group treatment setting
It is my understanding that these observations are to be used solely for the purposes of aiding the parent/guardian in observing their own child. Individuals observing groups will be reminded of confidentiality.
Safety is a top priority at the Carmen B. Pingree Autism Center of Learning. It is critical that we provide a safe environment for all children, staff members, and visitors. To help ensure the safety of all people involved, all staff members receive specific training in de-escalation techniques and non-physical crisis management.
Although we will make every effort to use the least amount of physical prompting or interaction with each child, there may be times that for the safety of your child and others, we may need to physically intervene using assistance or prompts with your child. This could pose potential risks to your child, other students, or the staff members involved, especially if the child is physically resistant to the prompt. Your child's teacher will always notify you if a situation occurred that required physical guidance. You will receive written or verbal notification from your child's teacher.
If a specific behavior is identified that requires more consistent physical intervention, your child's teacher will be in close communication with you to gain consent to complete a functional behavior assessment and develop a more individualized and comprehensive behavior intervention plan. This is typically appropriate if a teacher uses a physical intervention (that the student is resistant to) once a week, over three consecutive weeks. Please feel free to reach out to your child's teacher to address any concerns you may have regarding any behavior challenges and staff responses to those challenging behaviors.
I am aware that for the safety of my child there may be times that a staff member may need to provide physical guidance that my child is resistant to. I understand that even though the staff member will do everything possible to prevent injury, there is a possibility that my child may get injured, or injure another child or staff member.
We are happy to help facilitate transportation for families to and from the Carmen B. Pingree Autism Center of Learning. Our transportation services are provided as a courtesy service and may be affected by weather conditions and student safety plan needs and/or concerns. To maintain this service, we want to remind families that we have many children who use our bus services and to get all children to school on time we must keep a tightly scheduled bus run. Therefore, we will only wait 5 minutes at each bus stop. Also, children must use the same pick-up location and drop-off location daily.
If the situation arises that a child may demonstrate persistent patterns of problem behaviors on the bus, it may be warranted to remove the student from the bus for up to one week to ensure the safety of your child, other students, and staff on the bus. During this week, our team will conduct a functional behavior assessment of your child's behavior and update his or her safety plan to reflect any behavioral program changes warranted to ensure the safety of all students and staff on the bus.
Please fill out the attached form to specify your chosen stops. If you need to change the stops mid-year, please come to the front office to fill out a new pick-up and drop-off form and we will do our best to accommodate your request but cannot guarantee service based on seating capacity and route designation. Occasionally we make changes to stops to facilitate more efficient service, ensure better safety for students/staff, or to reach new families. If we change stops we will notify families as soon as possible.
Additionally, all children need to be picked up no later than 30 minutes after the end of school. Any children that are left here past that 30-minute time frame will be assessed a child-care rate of $80 per hour ($20 for every 15 minutes) plus additional costs associated with that extra care (snacks if needed, diapers, etc.)
Please select the pick-up and drop-off locations for your student. To review the bus schedule and route, click here.
Your Rights & Responsibilities
Read about the rights and repsonsibilities of you and your student during your time at the Carmen B. Pingree Autism Center.
Authorization To Use And Disclose Protected Health Information
The following form is to allow Carmen Pingree to access protected health information of the student.
Free & Reduced-Price School Meals
To complete the application for free and reduced-price school meals, please download the following form, fill it out, and return it to the Pingree Center.