2024-2025 Extended Day Registration Form
*As a reminder, spots in the EDP program will be filled on a first come, first served basis.

This form must be filled out before a registration payment will be accepted, and only one registration fee is required per family. For both returning and new RMS students, the $40 registration fee can be paid through the EDP MySchoolBucks, by cash, or by check (made out to Riverside Middle School) in mid-July.
Email *
Student Last Name *
Student First Name *
Student Middle Name *
Grade For 2024-2025 *
Birth Date
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Street Address *
City *
State *
Zip Code *
Parent/Guardian 1 Name *
Parent/Guardian 1 Email Address *
Parent/Guardian 1 Employer *
Parent/Guardian 1 Cell Phone Number *
Parent/Guardian 1 Work Phone number *
Parent/Guardian 1 Home Phone Number *
Parent/Guardian 2 Name *
Parent/Guardian 2  Email Address *
Parent/Guardian 2  Employer *
Parent/Guardian 2 Cell Phone Number *
Parent/Guardian 2 Work Phone Number *
Parent/Guardian 2 Home Phone Number  *
Legal Guardian Name(s) if different from above. If not put N/A. *
Legal Guardian Address if different from above. If not put N/A. *
Enrollment Information : Check all that apply *
Required
Does your child have any medical conditions or allergies should we be aware of? What treatment may be necessary? (Please note: There is no nurse available during the Extended Day Program.) *
Child's Doctor *
Doctor's Phone Number *
First Emergency Contact Name *
First Emergency Contact Phone Number *
First Emergency Contact Relationship to Child *
Second Emergency Contact Name *
Second Emergency Contact Phone Number *
Second Emergency Contact Relationship to Child *
By responding to this statement, I understand that the school will attempt to contact me in the case of an emergency such as an accident or serious illness. If I cannot be reached, I authorize the school to contact the doctor listed on this form and follow doctor's directions. If the doctor cannot be reached, I authorize the school to take whatever steps they deem necessary. *
I understand that a one-time a year, non-refundable fee of $40 per family will be required. If the child transfers to another school where a program exits, the $40 fee must be paid again. Please type your name below that you understand. *
Payments for the after school program are due by SUNDAYS  in advance of after school care for the following week. A 10% late payment fee will apply to all late payments, and repeated failure to pay fees will result in the child(ren) being withdrawn from EDP.  

Students must be picked up by 5:45pm. Late pick up fees of $2 per minute, not to exceed $20 per day, and repeated failure to pick up on time will result in the child(ren) being withdrawn from EDP.

If there is a problem with checks being returned, the director may require that payments be made in cash. Parents may not become indebted to the program. 

All schools operate on guidelines from Greenville County Schools. The cost of our program is very much below that of private daycare; therefore, fees must be paid whether or not your child attends a given week for any reason. 

If at any point you no longer need the services of our program, you may withdraw your child to avoid paying for weeks you do not need. If space is available, you may re-enroll your child if your circumstances change.
 *
Required
Name and email of person completing this form. 

By adding my name and email here, I understand all rules and regulations of the Extended Day program. I understand that my child(ren)'s spot will be held, but I am not assured a spot in EDP until the school has received the $40 registration fee AND I have verification from the school that my child is accepted into the program.
 *
Date *
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Do you need to register another child for the RMS EDP program? *
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