Settles Bridge After School Program
Star Time Registration will be limited to 20 students per grade level. Program hours will run from 2:15 to 6:00 pm daily. Fees will be $240 per month - all students will be considered full time with no "part time" slots available. Completion of this form and payment of the registration fee will put your child on the waiting list. You will be notified if your child(ren) has been accepted into the program. Please note ** this is a change in our procedure from previous years.
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Student's Name #1: *
Student's Grade #1: *
Student's Name #2:
Student's Grade #2:
Address *
Contact Phone # *
City *
Zip Code *
Mother's Name *
Mother's Work Phone # *
Mother's Cell # *
Father's Name *
Father's Work Phone# *
Father's Cell # *
Contact Email Address: *
Emergency contact other than parent and # *
Emergency & Release Information:                       *
In case of an emergency, release from school due to inclement weather, or early dismissal for any other reason, Star Time will not operate that day.  In this event, your child will be released based on prior arrangements made with your child's teacher.  However, if your child is already in Star Time we will call all individuals on this form until we get in contact with someone.  At that time, your child will be released to that individual.  If you have any special instructions please note them below.
Restricted Pick-up:                                                 *
List names of people who cannot pick up your child.
Special Instructions: *
(Allergies, Diet, Medical,Etc.)
Settles Bridge Star Time Pick-up List                                                                         *
Settles Bridge Star Time staff has my permission to release my child(ren) to the person(s) listed below.  I understand that these people will be contacted if I am late picking up my child(ren) and the Star Time Director is unable to contact me or due to an emergency release.** Note: ID will be checked.  
Name # 1 *
Phone # 1 *
Name # 2
Phone # 2
Parent Acknowledgement Statement                                           *
I have read and understand all of the guidelines set forth in the Star Time  Parent Brochure.  I have explained these rules to my child(ren) and have made them aware of the guidelines as well.  I understand that these same rules apply to the individuals that I have authorized to pick up my child(ren) on the pick-up list located in the Star Time registration form.    
Digital Signature                                                             *
Typing your name in the space provided will act as your signature.
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