Pansophia Academy Cub Club Registration
Attached is the handbook, please read the handbook before signing up your student.
Email *
Student First & Last Name *
Days student will attend. Please check all that apply. *
Student Grade & Teacher *
(1) Parent/Guardian Name, Phone Number (Work & Cell) *
(2) Parent/Guardian Name, Phone Number (Work & Cell) *
Emergency Contact/ Authorized Pick up - Name, Phone number & relation (List up to four) *
List any life threatening medical conditions / allergies? If none, please type N/A *
I here by authorize a trained school professional to administer emergency treatment to my student. *
If I am not available, I authorize that my son/daughter be taken to the nearest medical facility for treatment. *
Parents/Guardians using the free Cub Club Program services agree to the following: I understand all children, with no exceptions, must be able to maintain good behavior to stay in the Cub Club program. I further understand that extended Cub Club director has the right to immediately drop any child whose behavior endangers themselves, other children or the Cub Club staff. By signing below you agree to these terms. *
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