Winter 2019-2020 After School Program Registration
Ask and you shall receive! At the end of this registration process, you will be asked to continue on to our online payment option!! CONGRATULATIONS!

Directions:
1. Please complete one registration per child per course
2. Continue to the secure online payment website
If paying by check:
write your child's name and course in the bottom left hand corner - ONE PER CHILD PER COURSE
send in an envelope clearly labeled with child's name and course
3. You will receive email confirmation that you have registered for the course and a reminder to make payment.
4. You will receive an informational email from your course teacher within one week of course start date.
Email address *
POLICIES AND PROCEDURES: SESSION INFORMATION: Students must be picked up by the designated adult at the class location on time. After two notices, student may be removed from the ASP Class. COMMUNICATION: Families will be sent enrollment and payment confirmations via e-mail along with additional course information sent separately from the program instructor one week before the start of each class. Please be sure the email address you provide during registration is the email you will read most frequently as this is the method we will use to communicate cancelled classes or confirmations throughout the session. Make note of the dates of your child’s activity, remind your child and plan accordingly. No further reminders will be sent home. MAKE-UP POLICY: If there is inclement weather, classes held outdoors may be cancelled and parents will be notified by an e-mail that day. Every effort will be made to schedule a make-up class. However, if make-up classes cannot be scheduled in a timely manner, prorated refunds will not be issued. Refunds are not available. NO NURSING STAFF: Please note that these classes are offered after school hours at a time when health services are not available through the school. The school cannot provide health information to ASP instructors and they do not have access to any medications stored in the school clinic. It is the responsibility of parents to notify instructors of any health or medical needs. If there is an issue after school requiring health or medical attention, the session instructor will contact the parent or emergency contact listed.
Course - Winter 1/13-3/6 *
Student Last Name (ex. Appleseed) *
Your answer
Student First Name (ex: Johnny) *
Your answer
Grade *
Teacher Last Name *
Parent First and Last Name *
Your answer
Phone Number *
Your answer
Emergency Contact Name (different than above) *
Your answer
Emergency Contact Phone Number *
Your answer
How will your child get home from the program? *
Does your child have allergies or special needs? *
If you answered yes to the question above, please explain here
Your answer
If paying by check: 1. Provide check number (one per child/ course) 2. Write child name/course in the bottom left corner 3. Make payable to Belmont Station PTA
Captionless Image
Your answer
Payer Name - upper left hand corner of check (not needed if paying with credit card)
Your answer
Once you hit submit, the next window will prompt you to move to the payment page on the PTA website or give instructions on submitting your check. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy