BTX After School Program Registration
Please complete this form to request enrollment in the BTX After School Program.

Session Dates: August 10, 2026 through December 18, 2026

Tuition:
$70 per week for 1 child
$135 per week for 2 children
$205 per week for 3 children

Submitting this form does not guarantee placement. BTX will review your request and contact you to confirm availability and provide payment instructions.
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SECTION 1: CHILD INFORMATION
Child’s Name
 *
Birthday
 *
MM
/
DD
/
YYYY
School
Grade
BTX Member
Clear selection
SECTION 2: PARENT INFORMATION
Parent Name
 *
Parent Phone Number
 *
Email
SECTION 3: EMERGENCY CONTACT
Emergency Contact Name
 *
Emergency Contact Phone Number
 *
SECTION 4: PICKUP
List all individuals authorized to pick up your child.
Authorized Pick Up Person(s)
SECTION 5: AFTER SCHOOL DATE REQUEST
Select all dates your child will need our service.

BTX will review availability and confirm approved dates. You will only be charged for approved dates.

All approved dates must be paid in full by the Friday prior to attendance.

Select Requested Weeks

Additional Notes or Requests
SECTION 6: WAIVER
Waiver and Release
I, the parent or legal guardian of the child listed above, grant permission for my child to participate in the BTX Sports Fitness Club Program.

I understand that participation may involve physical activity and risk of injury. I assume all responsibility for any accident, injury, or loss that may occur.

I waive, release, and agree to hold harmless BTX Sports Fitness Club, its staff, volunteers, and affiliates from any claims or liability.

I understand this is a legal agreement. I have read and understand its terms and agree voluntarily.
Parent or Guardian Full Legal Name
 *
Date *
MM
/
DD
/
YYYY
SECTION 7: FORM AGREEMENT
I have read and agree to the waiver above and understand that by typing my name and submitting this form, I am providing my electronic signature which is legally equivalent to my handwritten signature.
Checkbox *
Required
Checkbox *
Required
SECTION 8: FINAL PAYMENT AGREEMENT
By submitting this form, you agree to pay for all approved dates whether attended or not.
Failure to pay may result in removal from the program and further action if necessary.
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