A.O. Elementary/Alamance-Burlington Daycare Student Registration 2024-2025

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Your child must be PRE-REGISTERED with our front office prior to filling out this form. You may call our office at (336-538-6030).

Email *

Grade Level For 2024-2025 School Year *

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Students Name: Last Name, First Name *

Child's Date of Birth *

mm/dd/yyyy

PRIMARY Parent/Guardian names, phone numbers, address, and e-mails *

Format: First & Last Name, Phone #s (specify cell, day, and home), Address, Email (If ABSS employee, please provide both ABSS email and an email address other than your ABSS address.)

Father/Guardian *

Work/Phone extension *

Cell # *

Home Address *

Email *

Mother/Guardian *

Work/Phone extension *

Cell # *

Home Address *

Email *

SECONDARY Parent/Guardian names, phone numbers, address, and e-mails *

Format: First & Last Name, Phone #s (specify cell, day, and home), Address, Email (If ABSS employee, please provide both ABSS email and an email address other than your ABSS address.)

Father/Guardian

Work/Phone Extension

Cell#

Address

Mother/Guardian

Work/Phone Extension

Cell#

Address

Is there any person prohibited from picking up the child by a court order? *

Yes

If yes, attach a copy of the court order and an explanation

Prohibited Persons Name and Relationship to the Child *

Is there a separation, divorce or custody agreement? We must have a copy on file in our school office of all court documents regarding the care and custody of the child. *

Yes

Yes, please explain *

Are you employed by Alamance_Burlington School System? *

Yes

If you are an ABSS employee,at what location? *

Emergency Contact and Pick Up authorization

The following people may pick up the child from the program and/or be reached during an emergency. In the event of inclement weather or an emergency situation. Please make sure you have made arrangements with these individuals to pick up your child/children from the program and they are accepting of this responsibility.**Please note a valid ID will be required to pick up students from daycare.

1st Pickup Name, Relationship and Phone# *

2nd Pick Up Name, Relationship and Phone# *

3rd Pick Up Name, Relationship and Phone #

Please list all allergies (food, insects, medications, etc) *

Please list any medications required to treat these allergies. (ABSS Medication Authorization should be on file with the school nurse) *

Emergency Permission *

I give permission to A.O. Elementary School Daycare staff to authorize emergency treatment and transportation of my child to Alamance Regional Medical Center

I DO NOT give permission to A.O. Elementary School Daycare staff to authorize emergency treatment and transportation of my child to Alamance Regional Medical Center

Field Trip (If Applicable) *

I give permission for my child to attend any off campus field trips on teacher workdays & permission for my child to be transported on ABSS buses for these trips.

I DO NOT give permission for my child to attend any off campus field trips on teacher workdays.

Movie Permission (If Applicable)

I give permission for my child to watch PG movies

I do not give permission for my child to watch PG movies

Clear selection

Homework Preference (note this option may not be available at you school please check with each individual location) *

I prefer that my child work on homework during afterschool

I prefer that my child DOES NOT work on homework during afterschool.

Participation and Payment Agreement **All Payments are due on the first day of each month** *

My child and I have read, discussed, and agree to abide by the rules, regulations, and payment schedule for attending A-O Elementary School Before and After School Program.

Please select Childcare Option *

AM Only

PM Only

AM & PM

Part Time PM (10 Days)

Submit

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