The Sunshine Academy - After School Adventures Registration Form
2019-2020 School Year
Primary Account Person - First & Last Name (who is paying tuition) *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Preferred Email *
Your answer
Relationship to Child *
Your answer
I plan on paying my tuition by *
Child's - Full Name *
Your answer
Date of Birth *
MM
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DD
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Gender
School *
Required
Grade *
Required
Which program do you wish to enroll in? *
Required
Does your child have any of the following? *
Required
Please list any allergies your child has - Indicate if they are life threatening
Your answer
Please list any medical conditions your child has
Your answer
How much does your child weigh? (children under 60lb are required to ride in a booster seat)
Your answer
Mother/Guardian - First & Last Name
Your answer
Mother/Guardian - Address
Your answer
Mother/Guardian - Phone Number
Your answer
Mother/Guardian - Work Phone Number
Your answer
Mother/Guardian - Place of Employment
Your answer
Does child reside with mother/guardian?
Father/Guardian - First & Last Name
Your answer
Father/Guardian Address
Your answer
Father/Guardian - Phone Number
Your answer
Father/Guardian - Work Phone Number
Your answer
Father/Guardian - Place of Employment
Your answer
Does child reside with father/guardian?
Doctor's Name & Phone Number *
Your answer
Insurance Carrier / ID Number / Group Number
Your answer
What is your preferred start date? Please note- registration can take up to 10 days during high volume times.
MM
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DD
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YYYY
Emergency Contact Person #1 - Name (Must be at least 18 years old and different from above) *
Your answer
Emergency Contact Person #1 - Phone Number *
Your answer
Emergency Contact Person #1 - Relationship to Child *
Your answer
Emergency Contact Person #2 - Name (Must be at least 18 years old and different from above) *
Your answer
Emergency Contact Person #2 - Phone Number *
Your answer
Emergency Contact Person #2 - Relationship to Child *
Your answer
Please list all persons authorized to pick up your child
Your answer
What are your child's current interests?
Your answer
What are your goals for you child from their after school experience?
Your answer
How did you hear about The Sunshine Academy? *
Promo Code
Your answer
I understand completion of this form does not guarantee placement in The Sunshine Academy's After School Adventures Program. I am aware registration is not complete until all registration forms are completed and returned and all registration fees are paid in full. *
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