Before & After School Registration Form

In the event that I am unable to pick up my child, the following individuals are permitted to do so.
Name:*

First NameLast Name
Cell Phone *

Area CodePhone Number
Relationship to child:*
Name:

First NameLast Name
Cell Phone

Area CodePhone Number
Relationship to child:

List all allergies or health conditions that are part of your child/ren's medical history:
I have read, understand, and agree to adhere to the guidelines set forth in the BASP policy, the Parent/Student Handbook as well as any modifications therein.

My signature below certifies that immunization information concerning my child has been provided and is available in the school office.
Parent/Guardian Signature:*

Clear
Date:*

MonthDayYear
Date
My Products*
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BASP Registration Fee$25.00

Total $0.00

Pay with PayPal

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.