Reingold Elementary School 21st Century 2025-2026 Afterschool Program Registration Form

Directions: 
Please complete ONE FORM FOR EACH CHILD.  

Notes: 
*If you DO NOT wish to register your child, DO NOT complete this form. 
*Parents MUST agree to the conditions below for their child to be enrolled. No exceptions will be made.   
1. All students are required to attend at least 80% of program days. Missing more than 20% of days without an acceptable excuse, such as illness or other extenuating circumstance, will result in dismissal from the program. 
2. All students must adhere to 21st Century Behavior Guidelines. 

Program Information: 

Dates and Times:
Session 1: 9/22/25-12/3/25 Monday-Thursday 3:25pm-5:55pm
Session 2: 12/15/25-3/12/26 Monday-Thursday 3:25pm-5:55pm
Session 3: 3/23/26-6/4/26 Monday-Thursday 3:25pm-5:55pm

Location: 
Reingold Elementary School 
70 Reingold Avenue  
Fitchburg, MA 01420

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Email *
I understand that my child may not have more than 20% of program days without a valid excuse and must follow all behavior guidelines. I wish to enroll my child in the 21st Century 2025-2026 afterschool program.  *
I understand that the program may include trips to offsite locations for various enrichment activities. I grant permission for my child to attend the trips that their groups will attend. (Note: Staff will inform families of planned field trip locations and dates.) *
Student First Name *
Student Last Name *
Current Grade *
Parent or Guardian Full Name *
Home Address *
Parent/Guardian Telephone Number *
Parent/Guardian Email Address *
Emergency Name & Contact Info (during afterschool program hours of 3:25PM to 5:55 PM) *
Will Your Student Need Bus Transportation?

Due to program restrictions all students will be dropped at the bus stops currently used by the district. 

Door-to-door drop-offs will not be possible for many students. Students will have to walk from bus stop to their home. We HIGHLY recommend that parents meet the younger students at the bus stop to accompany them home.

The First View app is available for our late bus routes also. 

Check "Yes" below to confirm your understanding of the above or select "No" if you will pick up your student instead.
 *
If you are doing parent pick-up, please list names of adults approved to pick up your child here. (Note: any changes must be submitted in writing and photo ID is required) *
Does your child currently ride with NRT special transportation? *
Required
Does your student currently receive services as part of an IEP or 504 plan? *
Does your student receive English language learner (ELL) support during the school day? *
List ALL of your child's medical needs or issues below, including medication your child takes.  If not applicable, enter "N/A."  *
List ALL of your child's dietary restrictions below. If not applicable, enter "N/A."  *
Is there any additional information we should know about your child? If so, include below. Otherwise, enter  "N/A."  *
I give permission for photos and video to be taken of my child for program and promotional activities. I understand that these may be shared on FPS social media accounts and website.  *
A copy of your responses will be emailed to the address you provided.
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