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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?*

20__ - 20__

Answer Required

Grade of Student*

Answer Required

Please indicate below what you are registering for:

Answer Required

Full Time

Part Time

Hourly

Time Child will be Picked Up*

Answer Required

Student Information

Allergies (N/A if no allergies) *

Answer Required

Gender *

Answer Required

Male

Female

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Address

Parent Information

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email 1*

Answer Required

Mobile Phone*

Number Required

Home Phone

Number Required

Work Phone

Number Required

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Emergency Contact

Relationship to Child*

Answer Required

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email 1*

Answer Required

Mobile Phone

Number Required

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/Part Time - Payments due at the 1st 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*

FULL NAME

Answer Required

Today's Date*

Answer Required