Brevard Academy Bulldog Care Registration 2019-2020 (Complete separate form for EACH student that will require After School services).
Safety is a top priority for the Brevard Academy’s Bulldog Care Program; therefore, no child will be released from the program without a parent/guardian signature or designated individual. (Note: The name below must be of someone 16 years or older.) Valid identification must be presented upon request. Please ensure that you have read the information provided on our website regarding Bulldog Care rates, hours, sign in/out information as well as parking instructions - some information may have changed from previous school years.
Email address *
Student Name: *
Your answer
Student Grade Level: *
Your answer
Student Homeroom Teacher: *
Your answer
Parent/Guardian #1 Name: *
Your answer
Parent/Guardian #1 Phone Number: *
Your answer
Parent/Guardian #2 Name:
Your answer
Parent/Guardian Phone Number:
Your answer
Non-Parent/Guardian Authorized Pick Up Designee #1 Name: *
Your answer
Non-Parent/Guardian Authorized Pick Up Designee #1 Phone Number: *
Your answer
Non-Parent/Guardian Authorized Pick Up Designee #2 Name:
Your answer
Non-Parent/Guardian Authorized Pick Up Designee #2 Phone Number:
Your answer
Non-Parent/Guardian Authorized Pick Up Designee #3 Name:
Your answer
Non-Parent/Guardian Authorized Pick Up Designee #3 Phone Number:
Your answer
First Day of Expected Bulldog Care Enrollment *
MM
/
DD
/
YYYY
Expected Days that Student will require Bulldog Care:
Does your child have any allergies or medical condition that the After School Staff should be aware of? If yes, please describe. *
Your answer
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