After School Program 2023-2024
Email *
After School Program 2022-2023
Name of Child *
Age *
Date of Birth *
Clear selection
Grade   *
Address *
Clear selection
Clear selection
Child Uses
Clear selection
Parent /Guardian Information
Employer *
Parent/Guardian name: *
Address *
Phone *
Work Phone *
Cell phone number
Email *
2 parent/Guardian Name: *
Marital status
Clear selection
If divorced who has legal custody? * A court order is needed if parent is denied access to the child. *
I authorize the following people to pick up my child from the After school Program. All authorized persons MUST BE AT LEAST 16 years of age and be prepared to show PHOTO ID.
Medical Information
Allergies and Special Needs
Does your child have any allergies *
Please list allergies
Does your child take any medication? *
Please List Medications
Does Your child have any special needs? *
Please Describe
Physician Information
Physician's name *
Office name *
Address of Office *
Phone Number
Fax Number
Please indicate if your child has a history of the following.
Clear selection
Conditions of Acceptance
Conditions of Acceptance
1. I agree to return all After School Program (ASP) enrollment forms to the Hamilton Hill Arts Center prior to my child(ren) starting Camp. Children may not participate in the After School Program until all forms are completed and on file with the Center.
2. I understand that any changes to my original registration must be submitted in writing.
3. I understand that the hours of operation for the After school program are Monday through Friday from 2:30p.m. until 6:00. Summer Camp Hours are 10am -3 p.m. Children are to be picked up by 6:00 p.m for afterschool program and 3:00pm for summer camp. *** A FEE of $1. per minute Will BE ADDED FOR LATE PICK UP STARTING AT 6PM
4. I understand that my child must comply with ASP rules and standards of behavior. I agree that the Center’s ASP Staff has the right to enforce appropriate standards of conduct and may dismiss a member who infringes on the rights of others.
5. I give my permission for the use of any photographs, slides or videotapes, which may contain my child, to be used in the Hamilton Hill Arts Center promotional materials as well as social media.
6. I give my permission for my child to be transported to and from ASP field trips and activities.
7. I certify that my child is capable of participating in ASP activities. This means that They are able to practice Basic self care ,defined as:
  •  The ability to go to the bathroom without assistance
  • The ability to eat without assistance
  • The ability to dress independently
  • The ability to clean themselves independently
In addition children must be able to:
  • Interact appropriately and safely with others
  • Explain what they need, and ask for help
  • Follow instructions.
8. I grant the Hamilton Hill Arts Center and it’s agents full authority to take whatever
 action they deem necessary regarding my child’s health and safety and I fully release the Hamilton Hill Arts Center and it’s agents from any liability in connection with those decisions.
9. I understand that this is a Drop in Arts Center NOT a Day Care! All children are welcome provided they meet the conditions above. No confirmation is necessary, once we have received your forms, children can begin immediately Children can come as often or as little as they would like.
Child's Name
Parent Signature (Type in your name here to signify your agreement with and understanding of the above statements)   *
The following information is for grant purposes. Please fill out these additional forms so that we can continue our  programing.
Please indicate if you have access any of these services:
Family of One ,Income size
Clear selection
Family of Two, Income size
Clear selection
Family of Three, Income size
Clear selection
Family of Four, Income size
Clear selection
Family of Five, Income size
Clear selection
Family of Six Income size
Clear selection
Family of Seven, Income size
Clear selection
Family of Eight or more, Income size
Clear selection
Arts and Crafts classes are drop in and as such many projects will be able to be completed in one day, participants are not required to attend regularly.

 For the Special classes we ask that children attend with some consistency in order to allow them to progress in their lessons.

Special needs classes are smaller and run by a teacher who is experienced teaching Art to individuals with special needs. This is for the student who may need some extra attention and quiet in order to participate. Spots are limited and will be given on a first come first serve basis. Call 518-346-1262 to find out if there is space available and so that we can determine together if this is a good fit for your child.

African Dance and Drumming and Capoeira will be starting soon! This registration form will be updated to allow you to register for these classes as soon as they become available.
Untitled Question
Clear selection
Clear form
Never submit passwords through Google Forms.
This form was created inside of Report Abuse