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BASE Registration: 2024-2025
Explorer families, please fill out one registration form for each student who will be attending.

BASE is open every school day from dismissal until 6:00pm.
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Email *
Name of Adult filling out this form *
Primary Phone Number *
Your Relationship to Student *
Student Information
Student First Name *
Student Last Name *
Preferred Name (If different from above)
Birthday *
MM
/
DD
/
YYYY
Grade (During the 2024-2025 school year) *
Known Medical Conditions (Please include if student uses an inhaler and/or EpiPen) *
Emergency Contacts and Authorized Pick-Ups
#1 - Name and Relationship to Student *
#1 - Phone Number *
#2 - Name and Relationship to Student *
#2 - Phone Number *
#3 - Name and Relationship to Student *
#3 - Phone Number *
2024-2025 BASE Registration Agreement
2024-2025 Registration Agreement
Parents/guardians, please read the 2024-2025 Registration Agreement thoroughly. Type your name below to acknowledge that you read, understand, and will abide by the conditions of the entire registration agreement. By entering your name below, you are acknowledging that you received a copy of the BASE Program Registration Agreement and you understand the hours of operation, rates, and your responsibility to obtain the invoice for services through ProCare and make payment for such services. This registration agreement becomes effective the first day of care and supersedes all previous agreements. *
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