2024-25 CHAMPS Registration Form
2024-2025 Afterschool Registration Form  Accepting K5-5th grade students only  
ALL DEPOSITS MUST BE PAID BY CHECK/MONEY ORDER- YOUR SPOT WILL NOT BE RESERVED UNTIL DEPOSIT IS PAID.
$40.00 REGISTRATION NON-REFUNDABLE DEPOSIT
Email *
Email
Child's Name
Age as of (7/31/2024) *
Date of Birth *
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Grade for the 24-25 School Year *
Address *
Home Phone *
Mother's Name and Work Phone *
Mother's cell Phone *
Father's Name and Work Phone *
Father's Cell Phone *
Emergency Contact #1 NAME AND NUMBER *
Emergency Contact #2   NAME AND NUMBER *
Persons Authorized to Pick-up Your Child  (Name and phone number) ONLY THOSE AUTHORIZED WILL BE ALLOWED TO PICK UP YOUR CHILD. *
I give my permission for my child to access approved internet sites on Chromebooks. *
I give my child permission to watch movies rated G & PG. (A complete list of our movies is available upon request.) *
I give permission for the CHAMPS Academy to use my child’s name and/or pictures as a part of a news account or promotional materials related to the CHAMPS Academy. *
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