After School 2023/24 Registration/Payment Form

Is your child a returning After School student?

YesNo

Student's Name *

First NameLast Name

Student's Preferred Pronoun

Example: He/him, She/her, They/Them, prefer not to answer

Student's Birth Date*

Must be 5 yo or approved by CBK if under 5

School they attend *

Grade*

Will a sibling be joining them in class?

YESNO

Sibling's Name *

First NameLast Name

Sibling's Birth Date*

Must be 5 yo or approved by CBK if under 5

Sibling's Preferred Pronoun

Example: He/him, She/her, They/Them, prefer not to answer

School they attend *

Grade*

Will the sibling be joining all the same classes?*

YESNO

Please list what classes they will take, if not togther

Will a third sibling be joining them in class?

YesNo

Sibling's Name *

First NameLast Name

Sibling's Birth Date*

Must be 5 yo or approved by CBK if under 5

Sibling's Preferred Pronoun

Example: He/him, She/her, They/Them, prefer not to answer

School they attend *

Grade*

Will the sibling be joining all the same classes?*

YESNO

Please list what classes they will take, if not together

Parent/Guardian Name*

First NameLast Name

Main Phone Number*

Cell phone preferred

Parent Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name*

First NameLast Name

Phone Number*

Cell phones are preferred

Email*

example@example.com

Health Care Provider*

Health Care & Group Number*

member number Group number

Please list all ALLERGIES and or any other health/non-health related information you think we should know about your child.

The more information you can provide regarding any additional needs your child may have, the better are able to support them in the classroom.

After School Options ** TO ADD CLASS TO CART - CHECK UPPER LEFT-HAND CORNER OF THE CLASS YOU WANT - CHECK YOUR TOTAL BEFORE SUBMITTING FORM**

Monday's | Wheel Thrown Wares | 1/29 - 6/10 Product Image

Monday's | Wheel Thrown Wares | 1/29 - 6/10Class time 4 - 6 pm | This is a 15-week class. **PICK UP IS CONFIRMED AT DTES/BPCS**

$870.00 Quantity

Tuesday's | Breaking the Mold | 1/30 - 6/11 Product Image

Tuesday's | Breaking the Mold | 1/30 - 6/11Class time 3:30 - 5:30 pm | This is a 17-week class **PICK UP CONFIRMED PS 20**

$986.00 Quantity

Thursday | The Art of Animation | 2/1 - 6/13 Product Image

Thursday | The Art of Animation | 2/1 - 6/13Class time 3:30 - 5:30 pm | This is a 17-week class. **PICK UP CONFIRMED PS 282**

$986.00 Quantity

Friday's | Fashion Forward | 2/2 - 6/14 Product Image

Friday's | Fashion Forward | 2/2 - 6/14Class time 3:30 - 5:30 pm | This is a 16-week class. **PICK UP IS NOT CONFIRMED**

$928.00 Quantity

Enter coupon

Total

$0.00

SIBLING DISCOUNT:

Siblings MUST attend together to receive USE CODE BLING

PPLAN WILL NOT WORK WITH THE SIBLING CODE, WE WILL ADJUST THE BALANCE OWED WHEN THE SECOND PAYMENT IS DUE SO ONLY USE CODE PPLAN IF YOU ARE OPTING INTO OUR PAYMENT PLAN

ARE YOU OPTING INTO OUR PAYMENT PLAN FOR WINTER?*

YesNo

Did you opt into our pplan in the FALL and all CC information is the same?

Yes, all CC information is the sameNo, I did not opt-in for fallYes, but CC information changed

Payment Plan Agreement:

An invoice will be sent at least 2 weeks before the second and final payment is due. The due dates are:

Monday: 3/25

Tuesday: 3/26

Thursday: 3/28

Friday: 3/29

We will automatically charge your CC your balance owed plus a $50 late fee if payment is not made within seven days of your due date.

PLEASE READ ALL INFORMATION BELOW IF THIS IS YOUR FIRST TIME ON OUR PPLAN OR IF YOUR INFORMATION HAS CHANGED

DISCOUNT CODES:

If you choose to enroll in our payment plan you must download, read, and fill out the form below. Once you have finished there is a space to upload it on this form before you submit your registration. There is a $25 fee to enroll in our payment plan.

USE CODE PPLAN above, where it reads Enter Coupon

THE SIBLING DISCOUNT CODE DOES NOT WORK IN CONJUNCTION WITH THE PAYMENT PLAN CODE, WE WILL ADJUST YOUR INVOICE TO REFLECT THE DISCOUNT FOR THE SECOND HALF OF THE PAYMENT. ONLY ENTER PPLAN CODE

PAYMENT PLAN AGREEMENT REQUIRED TO SUBMIT FORM - IF YOU OPTED FOR OUR PAYMENT PLAN PLEASE DOWNLOAD OUR AGREEMENT, FILL IT OUT, SIGN AND UPLOAD IT BELOW. WE NEED THIS COMPLETED IN ORDER FOR YOU TO REGISTER.

Are you part of a group pick up*

Yes, it has been confirmedNo, I will be dropping my child off at the studioI would like to be but if my school is not confirmed I will drop my child off

IF YOU ARE IN A CONFIRMED PICK UP PLEASE FILL OUT AND UPLOAD THIS FORM - IF YOU ARE IN A CURRENT PICK UP ON THE SAME DAY AND ALL INFORMATION IS THE SAME AS THE FALL YOU DO NOT NEED TO FILL THIS OUT AGAIN

UPLOAD PAYMENT PLAN AGREEMENT & RELEASE FORMS HERE

TERMS & CONDITIONS

All registration sales are final; no refunds will be issued. In the event of temporary studio closure at any point during the school year due to government recommendations/public health and safety, all classes may move online depending on the length of the closure. We regret that we will not be able to offer refunds in this event, as we incur much of our costs upfront as a small family-owned business and make preparations well ahead of time for your child to have the best experience with CBK. If we are unable to provide online classes, we will be in contact with families on how we will make up the missed time. It has been and will continue to be our priority to provide the students with the full content of any classes missed due to a shutdown.

By registering for in-person classes, you agree to accept online classes (when available) in lieu of a refund in the event of temporary closure beyond our control. If a child misses any classes whether it is due to any illnesses, or is recommended by the DOH to quarantine no refunds or make-up classes will be given. We will do all we can to make sure they are caught up when they are able to return to class. Given the current guidelines due to COVID there could be a chance your child might miss class, so please be mindful of this before you register.

By signing below you have read to and agreed to our Terms & Conditions

Clear

Date Signed

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

After School Registration Form & Payment

STUDENT'S INFORMATION

SIBLING INFORMATION

PARENT/GUARDIAN INFORMATION

Emergency Contact Information

Medical Information

PAYMENT PLAN CODE: PPLAN

PLEASE SLOW DOWN AND READ BELOW CAREFULLY!!!

STOP PLEASE DO NOT SUBMIT THE FORM MORE THAN ONCE - IF YOU GET AN ERROR MESSAGE REACH OUT TO