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Spring 2026 After School Registration
Please use a separate form to register
EACH
child you would like to sign up.
You will receive an invoice via e-mail stating your total due within 3 business days of your registration submission.
Please be sure to list an email address you regularly check.
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* Indicates required question
Email
*
Your email
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Class
*
Your answer
Parent's Name
*
Your answer
Parent E-Mail
*
Your answer
Secondary Email (Optional)
Your answer
Home Phone Number
*
Your answer
Cell Phone Number
*
Your answer
Work Phone Number (Optional)
Your answer
Additional Parent Contact Number (Optional)
Your answer
AUTHORIZED PICK UP PERSON/EMERGENCY CONTACT
Please list two people, other than yourself, who are allowed to pick up your child.
Name of first authorized pick up person/emergency contact:
*
Your answer
Relationship to Student
*
Your answer
Phone Number of Contact
*
Your answer
Name of second authorized pick up person/emergency contact:
*
Your answer
Relationship to Student
*
Your answer
Phone Number of Contact
*
Your answer
Is there anyone who MAY NOT pick up your child?
*
Yes
No
If "Yes" to the above question, please name the individual who may NOT pick up your child.
Your answer
Applicable for grades 4 and 5 ONLY
Would you like your child to walk home alone at 5:30? IF "YES" YOU MUST SEND IN A SIGNED NOTE GIVING YOUR CHILD PERMISSION TO WALK HOME ALONE AT 5:30 FROM AFTER SCHOOL.
Yes, please allow my child to walk home ALONE at 5:30. I will send in a signed note confirming this request.
No, my child will be picked up.
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ALLERGIES
Please list any allergies your child has. If your child does not have allergies please write N/A
*
Your answer
Does your child have an EPI-Pen?
*
Yes
No
Days
Please select "yes" for any day your child will be attending our self-sustaining after-school program.
Select "no" if your child will not attend on that day.
Monday - (17 SESSIONS $425)
*
Yes
No
Tuesday -(18 SESSIONS $450)
*
Yes
No
Wednesday - (17 SESSIONS $425)
*
Yes
No
Thursday - (14 SESSIONS - $350)
*
Yes
No
Friday - (14 SESSIONS $350)
*
Yes
No
Are you registering another child? Your first child is full price. Additional siblings will receive a 10% discount.
*
Yes, I am registering more children for this program.
No, I am only registering one child for this program.
If you are enrolling additional children, please list their name(s) and class(es) below. *Each child must be registered on a separate Google form.
Your answer
We plan to share pictures with parents through an online platform. Do we have your consent to take and post pictures of your child enjoying their time in our after-school program?
*
Yes, I consent to my child's picture being taken, and posted in the chosen online platform.
No, I do not give consent.
Please click this link to read the attached After School Code of Conduct
*
My child and I have read and understand the "After School Code of Conduct"
Parents, by placing your name below you agree to electronically sign off on this google form and the Code of Conduct included.
*
Your answer
Send me a copy of my responses.
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