5-8 Club Registration
Central Park School for Children After-School Clubs
4th Quarter 2016/2017
Student Information
PLEASE FILL OUT ONE FORM PER CHILD!
Child's name
Your answer
Grade
Parent's name
Your answer
Parent's email address
Your answer
Parent's contact number
Your answer
Clubs enrolling for
Required
Total money I commit to pay for this child
Your answer
Emergency Contacts (2)
At least one of these must be a parent or guardian
Contact 1 name and phone
Your answer
Contact 2 name and phone
Your answer
Waivers
= CPSC may use photos taken of my child at ASC on the CPSC website and in other promotional materials. Per CPSC policy, my child will not be identified by name in any publication.

= All policies in CPSC’s Parent Handbook also apply to CPSC’s After School Clubs. If my child consistently struggles following ASP rules, my child may be suspended or asked to leave the club until appropriate behavior can be re-established.

= I understand that I am financially responsible for any CPSC property lost or damaged by my child. I will also discuss this with my child.

Please check that you accept:
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Please provide any health and behavioral information that will help keep your child safe and happy.
Your answer
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