Halifax Youth and Recreation After School Sports Registration
Please complete and submit this form in order to register your child for After-School Sports. Please send in payment to the school by form of check, made out to the Town of Halifax, prior to the session starting.

1 child - $40/session. Prepay for all sessions (8th session free) - $280
2 children - $65/session. Prepay for all session (8th session free) - $455
3 children or more - $85/session. Prepay for all sessions (8th session free) - $595
Student Name *
Your answer
Teacher *
Required
Grade *
Sessions *
Required
Health Conditions (medications, allergies, etc.) *
Your answer
Cell Phone *
Your answer
Alternate Phone *
Your answer
Email *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Does your child attend the YMCA program on the day that his/her group meets? *
Parent Carpool: Please list the names of all individuals that you authorize to pick up your child. Any individuals not listed will need permission with a note. (Proper identification will be required.) *
Your answer
Please re-type the following statement and write your name at the end: I give (student's name) permission to be dismissed to the gym lobby on (list days). *
Your answer
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