Bells After School Registration Form
Registration for After School and All Day Care.
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Email *
Handbells Instruction
All students receive FREE pickup at school, FREE Snack, Music Instruction, and homework learning support, All supplies provided.
Student Name *
Student’s Grade in School? *
Student’s Age *
Student’s Birthday *
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School Your Child attends?
Do you want us to pick up your child at school?
Each school has different pick up regulations.  You will need to call the school and authorize BELLS AFTER SCHOOL to pick up your student(s). For before school care  students, they can be dropped off as early as 7:00 a.m. and picked up as late as 6:30 p.m. without any extra charge.  For extreme  before  school  care students, they can be dropped off as early as 6:00 a.m. You are only charged for the days you attend.  There is no charge for missed days. For before care students you must notify us 24 hours in advance or you will be charged for the before care fees. Exceptions are made for illness with a 1 hour notification.
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Parent/Guardian Name *
Parent’s Email Address *
Primary Phone Number *
No dashes please.  Please give us the number we can call you at when your child is in class.
Secondary Phone Number
Emergency Contact Person *
Emergency Contact Number *
Emergency Contact Number 2 *
Person Authorized to Pick up Your Student *
We check ID’s
Person Authorized to Pick up Your Student
We check ID’s
What days do you want us to pick your child up
Check all that apply.  A minimum of two days is required.
Your First Week is Always Free!  We will make payment arrangements with your when we meet in person. To notify us if your child can't attend you can either call us at 540-356-0104 or you can email us at basdailynotes@gmail.com
A copy of your responses will be emailed to the address you provided.
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