After School (ASK) Registration Form

Please complete the form below. Required fields marked with an asterisk *

After School Enrichment Program is for grades: Kindergarten-5th Grade. If your child is older please check out our after school sports/clubs.

What year are you registering for?*
Grade of Student*
Please indicate below what you are registering for:*
- Full Time
- Part Time
- Hourly
Time Child will be Picked Up*

: HH

MM
Student Information
Allergies (N/A if no allergies)*
Gender*
- Male
- Female
First Name*
Middle Name
Last Name*
Address
Parent Information
First Name*
Middle Name
Last Name*
Email 1*
Mobile Phone*
Work Phone
Home Phone
Street Address*
City*
State*
Zip/Postal*
Emergency Contact
Relationship to Child*
First Name*
Middle Name
Last Name*
Email 1*
Mobile Phone*
By typing my full name and today's date, I agree to the following terms and conditions, which are binding for payment of after school care for one academic year.
- Full Time - Payments due at the 1st of each month.
- Part Time - Payments due at the 3rd of each month.
- A $50 fee will be charged for all checks returned by the bank or invalidated for any reason. FAILURE TO MEET PAYMENT OBLIGATIONS WILL RESULT IN SUSPENSION FROM ASK PROGRAM UNTIL ACCOUNT IS CURRENT.
  ARITRATION: All disputes over the terms of this agreement or an incident/accideny that occurs on the Ribet campus that cannot be resolved will be submitted to binding. Arbitration in accordance with the American Arbitration Association.
- Ribet student/parent images, likenesses and/or voices may be used for our marketing purposes.
Signature*
Today's Date*
Date Format: MM slash DD slash YYYY
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