Abernethy Garden Afterschool Program Registration
This is the registration form for 2016-2017 school year (fall enrollment). The class list for fall has been filled, but we will continue to accept registrations after the program is full, adding all registrants to the wait list, which we maintain all year.

If you have questions about the program, please visit http://gardenofwonders.weebly.com/garden-afterschool1.html.

Registration for 2016-2017 School Year - Wait List
Please note that the class list for fall 2016 has been filled. We will continue to accept registrations, adding all registrants to the wait list, which we maintain all year.
Are you registering more than one child for this program today?
Please note! If you are registering more than one child, you will need to fill out one form per child.
Child's Name
Your answer
Child's Grade Level (Fall 2016)
Your Child's Teacher's Name
Your answer
Day(s) of the Week Requested
Please check all that apply below. We will build your schedule based on your request and availability.

If your needs are flexible in terms of your choice of days, please be specific when you give details below.

Please check all that apply.
Required
Your answer
Contact and Emergency Details
Parent 1 Name
Your answer
Parent 1 Email
Your answer
Parent 1 Phone
Your answer
Parent 2 Name (Optional)
Your answer
Parent 2 Email (Optional)
Your answer
Parent 2 Phone (Optional)
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone
Your answer
Person(s) authorized to pick up child other than parent(s) you listed above
Your answer
Person(s) who may never pick up your child (optional)
Your answer
Allergies?
Your answer
Medical Plan Provider
Your answer
Authorizations and Agreements
Parent or Guardian Authorization - Medication
My child may be given non-prescribed medication as indicated on the container. This may include sunscreen or anti-bacterial first aid cream. Syrup of ipecac may be administered if deemed necessary by the poison control operator. The child's parent or guardian will be contacted prior to administering non-prescription pain relievers. Prescription medications must be current and a permission slip is required per each medication.
Required
Parent or Guardian Authorization - Medical Assistance
In an emergency, the program teacher has my permission to call an ambulance, or take my child to any available physician or hospital at my expense to obtain medical treatment.
Required
Garden Afterschool Program Disclaimer
I understand the School District No. 1, Multnomah County and Abernethy School provides only space for the Garden Afterschool Program. Abernethy School does not supervise the care or provide program staffing or program transportation, and I will not expect Abernethy School to take any responsibility for the care of my child.
Required
Tuition Payment Agreement
By checking the box below, I agree to the following payment terms defined by the fee schedule: a) I understand that tuition is due by the 5th day of every month and that a $25.00 late fee will be imposed if tuition has not been paid on the supportabernethy.org website by the 15th of each month; b) I understand that the Garden Afterschool Program closes at 5:30 pm and I am responsible for compensating the Garden Afterschool Program teacher on duty with payment of $1.00 for every minute after 5:35 that I am late; and c) I understand that I may be charged a fee if I remove my child from the program one or more days per week without giving one month's notice.
Required
Enrollment Agreement
By checking the box below, I agree to the following enrollment terms: By registering my child in the program, I commit to GAP enrollment for a full term (fall, winter, or spring). I understand that my child will be automatically re-enrolled into the next term for the same schedule unless one month’s notice is given by a parent requesting otherwise. If I remove my child from the program or I need to change the number of days attending, I agree to give one month's notice. I understand that GAP cannot guarantee a refund for unused days in the event that I remove my child from the program with less than one month’s notice.
Required
Important Note: Please be aware that by checking the box immediately above, you agreed to give one-month's notice in the event that you change enrollment days or fully remove your child from the program once accepted.
Once you click submit, please scroll up to the top of the page to find your confirmation.
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