Later Gators Registration

Later Gators After School Care Registration

PLEASE NOTE: Kidtopia After School Care Program is available to Pre-K through 6th grade students of Mt Carmel Elementary, Riverton Elementary, and Riverton Intermediate School on a first come basis. Once all seats have been filled, a waiting list will be started. A $75 registration fee per school year per child and the first week payment of $75 is due to reserve placement of your child in the program. A two week written notice is required to withdraw from the program. All payments are non transferable and nonrefundable. The start date for after school care begins on the first day of school.
Child's Information
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Please select your child’s school:
School Year
Grade Level
Your Child's Teacher
Parent/Guardian Information
Parent/Guardian #1

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
E-mail
example@example.com
Parent/Guardian #2

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Does the child have any allergies, chronic illness, or medical conditions?
If yes, please explain:
For Riverton Elementary school students: I give permission for my child to board the Kidtopia bus or Kidtopia van at their school and unload at the Kidtopia facility.
For Mt Carmel & Riverton Intermediate school students: I give permission for my child to board the bus at their school and unload at the Kidtopia facility.
I understand that Kidtopia After School care program is an active program with physically challenging activities available for student participation.
I understand that facility play, climbing walls, indoor and outdoor play equipment, inflatable obstacles, and all activities entail certain risks. Those risk can include increased heart rate, blood pressure, strained or sprained muscles, fractured bones, partial or complete paralysis, heart attacks, psychological injury, death, or possibility of any other serious injury. I elect to allow my child to participate in any and all activities in spite of these risks.
I understand that my child will be asked to sit quietly for a short period of time each afternoon to complete homework. ( If child does not have homework, coloring activities, appropriate computer game play, or quiet playtime is acceptable.)
I understand that my child may be photographed and photos may be used in media publications that would represent Kidtopia and its program in a positive manner.
I knowingly and voluntarily assume all risks involved in my child's participation and do hereby release Kidtopia, and its members, trustees, officers, employees, independent contractors, and agents from any and all liability, damages, costs, and expenses arising out of or relating to bodily or psychological injury, loss of life or personal propery that may occur as a result of participating in this program, regadless of cause.
My child and/or I have read, understand and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation in the program.
I understand that registration and first week payment is due to ensure child's enrollment and is non-refundable.
I understand that failure to pick up my child before 6 pm will result in a late fee of $1 per minute each minute past 6 pm that will be applied to the account.
I understand that the weekly tuition/care fee must be pre-paid the Monday prior to care or a $5 late fee will be applied to the account each day payment is not received.
I agree to give a two week written notice if I would like to withdraw my child from the program. The remaining balance must be paid in full at the time of notice.
I understand that bad language and behavior that is disruptive, disrespectful, and/or aggressive will not be tolerated and further agree that dismissal of my child is at the discretion of the Program Director.
Kidtopia has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.
Type First and Last name above to consent
Sign Enrollment Agreement
Date Signed

MonthDayYear
Date

My Products

Registration Fee

$75.00

Total

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Later Gators After School Care Registration

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