PS 84 EnviroSci & Garden Afterschool Registration Form

PS 84 EnviroSci-Garden Aftercare Enrichment Workshops Registration Form

Kindergarten- 5th grades
Back for the 2022-2033 school year!

The Environmental Science and Garden Aftercare Workshops provide students with hands-on activities to
learn about their role in ecology.

They learn to know and grow healthy and delicious fruits,
veggies, and herbs in the garden!
- Activities are rich in academic connections to science, social studies, math, language arts, nutrition, physical fitness, and creative arts!
- It also supports social-emotional growth as students
  learn in a relaxed atmosphere with their peers.
Visit our site for details.

We are a single-focus workshop provider.

DOE Vendor #BEA223146
NYC and State MWBE- FMS Vendor #VC00229957
RATES
- $35/day per child
- Enrolling Siblings, please fill out a form for each child.
  Discounted rate at checkout.
- Financial Assistance rates available with proof of income.
  (2 years tax returns or NYS benefit letter)
DETAILS

Days: Monday- Tuesday- Wednesday- Thursday- Friday

From: 2:40-*5:45pm

Fall- Sept 12 - Dec 23: 15 weeks
Active Outdoor/Indoor Gardening
Study of our cultural and local connections to plants and place, compost and soil study, long-term art/build projects, seasonal harvest & putting the garden to bed.

Winter- Jan 3 - Mar 10: 9 weeks
(closed Feb 20-24)
Active Indoor Gardening
Indoor garden-based work, seed starting, preserving food, market prep, technology-supported lessons, insect study, continue long-term art/build projects.

Spring- Mar 13 - Jun 16: 13 weeks
(closed April 8-14)
Active Outdoor/Indoor Gardening
Waking up the garden, weather, and patterns of nature study, planting, harvest markets, complete long-term art/build projects

Notes:

Students will be in mixed-aged groups, K-2 and 3-5 each day, fostering teamwork and social-emotional growth.
Which day(s) do you need aftercare?

Mondays Tuesdays Wednesdays Thursdays Fridays
Select days needed for aftercare. *
Which semester(s) do you need aftercare? *

Fall- September 12-December 23 Winter- January 3-March 10 Spring- March 13- June 16
Student Information
- All paid registrations are received and reviewed in a first come, first serve basis.
- Upon filling all open spots, all additional submissions will be added to our waiting list.
Student First Name *
Student Last Name *
Grade Attending *
Gender *

Female Male Non-Binary Other
Birth Date *

Month Day Year
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Does your child have siblings in school?
yes or no?
If yes, would you like them in the same group?
Please fill out a separate application for each child.
Would your child like to be in the same group with a friend?

Yes No
If yes, name, age and grade of the other child.
We will do our best to accommodate, subject to enrollment space.
Does your child have any allergies? *

Yes No
If yes please list, including any food or drug allergies.
Does your child have any medical conditions or require medication? *
Must already be reported to the school.
Is there anything else we should know about your child?
Parent/Guardian Information 1
Full Name *

First Name Last Name
Cell *

Area Code Phone Number
E-mail *
example@example.com
Home

Area Code Phone Number
Work

Area Code Phone Number
Address - Same As Child

Yes No
Parent/Guardian 1 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Information 2
Full Name

First Name Last Name
Home

Area Code Phone Number
Cell

Area Code Phone Number
Work

Area Code Phone Number
E-mail
example@example.com
Address - Same As Child

Yes No
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact - Other than Parent/Guardian
Full Name *

First Name Last Name
Cell *

Area Code Phone Number
Alternate Phone #

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please list all the people authorized to pick up your child. *
They will need ID at pickup.
Photo & Media Release

I understand and give permission for my child and their artwork to be photographed. I authorize Beazer’s Garden Workshops, now or hereafter, to use such photographs for any lawful purpose, including publicity, illustration, advertising, and waive any claims or interest to control the use of the images to market future projects.

I understand that there will be no financial or other remuneration for the photos, either for initial or subsequent transmission.
I have read and understood the above. *

Yes, I give permission No permission
Sign for either option *

Clear

Please select 1 (one) Child Rate option, days and semesters of aftercare.

1 Child/1 Day a Week-$35/day

Semester(s)	How Many Days a Week?	Price
Fall- 15 weeks		$ 525.00
Winter- 9 weeks		$ 315.00
Spring- 13 weeks		$ 455.00

Item subtotal: $ 0.00

Sibling Rate- 1 Child/1 Day Week-$30/day

Semester(s)	How Many Days a Week?	Price
Fall- 15 weeks		$ 450.00
Winter- 9 weeks		$ 270.00
Spring- 13 weeks		$ 390.00

Item subtotal: $ 0.00

Donation to PS 84 PTA Fund $ 50.00

Support all the parent-funded programs and activities at PS 84! If you'd like to donate any amount.

Total $ 0.00

School Closings by day of the week. Subtract from your total.

Fall- Sept 12- Dec 23
Mondays— 9/26, 10/10
Tuesdays- 9/27, 11/8
Wednesdays- 10/5
Thursdays- 11/3, 11/24
Fridays- 11/11, 11/18

Winter- Jan 3- Mar 10
Mondays- 1/2, 1/16
Tuesdays———
Wednesdays———
Thursdays- 3/9
Fridays———

Spring- Mar 13- June 16
Mondays- 5/29
Tuesdays——
Wednesdays——
Thursdays- 3/9, 4/6, 6/8
Fridays- 3/24, 4/7, 4/21, 6/9
After you submit the application, you will receive a Jotform confirmation with your child's registration info and a Paypal invoice.

Please use one of these preferred methods of payment:

1. Zelle to busyasabeazer@msn.com (it will appear as Beazer's Garden Body, Bath & Home, Inc. dba/ Beazer's Garden Workshops)

or,

2. Mail a check to:

Kimberly Beazer
Beazer's Garden Workshops
3464 Jerome Ave
Unit 672224
Bronx, NY 10467

or,

3. *for credit cards, please use your bank account and routing number instead of typing your debit card number.

Check here for more payment options and information.

If you have any questions please email Ms. B at info@beazersgarden.com
Should be Empty:

PS 84 EnviroSci-Garden Aftercare Enrichment Workshops Registration Form

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Emergency Contact - Other than Parent/Guardian