PS 84 EnviroSci & Garden Afterschool Registration Form

PS 84 EnviroSci-Garden Afterschool Enrichment Registration Form 2022-2023

Kindergarten- 5th grades
The Environmental Science and Garden Afterschool Enrichment program at PS 84 with Ms. B gives students an opportunity to engage in activities that enhance their understanding and application of academic subjects in a relaxed atmosphere and develop their interest in caring for the environment.

We provide:
- Families with a reliable resource for after school care
- A safe supervised environment for students to socialize with their peers
- Student Support Services- Engaging educational activities that connect Science, Technology, Engineering, Art, Math, Social Studies, Literacy and Social Emotional Learning through gardening, ecology, sustainability and nutrition long term projects
- Exposure to CTE and Green Career Pathways- we learn about the variety of green jobs in our city
- Civic, Community Engagement & Environmental Stewardship Projects to care for the community inside and out of the school building
- Homework time
DETAILS

Monday- Friday, 2:40-*5:45pm

37 weeks
Fall- Sept 12 - Dec 23 : 15 weeks
Winter- Jan 3 - Mar 10: 9 weeks (excludes Feb 20-24)
Spring- Mar 13 - Jun 16: 13 weeks (excludes April 8-14)

Students will be in mixed-aged groups, K-2 and 3-5 each day, fostering teamwork and social-emotional growth.

*Students signed up for other afterschool programs at 4:20pm, will be taken down to their next location and dismissed with that program.
RATES: One day a week

-Cost per child is $1295, one day a week for 37 weeks. ($35/wk)

-Sibling rate is $1110, one day a week for 37 weeks. ($30/wk)

-Limited Financial Assistance spots for qualified families. One day a week for 37 weeks = $925 ($25/wk).

Provide documentation to info@beazersgarden.com

~~~~~~~~~~~

Additional days may be added at 10% off the day rate. Automatically calculated at checkout.

You will be invoiced and can do installment payments.

Ex: 5 days a week

Regular rate ex: $35day x 5days = $175wk x 37wks = $6475- 10%= $5827.50 per child

Sibling rate ex: $30day x 5days = $150wk x 37wks = $5550 -10% = $4995 per child

Financial Assistance rate ex: $25day x 5days = $125wk x 37wks = $4625- 10% = $4162.50 per child
Which day(s) do you need aftercare? *

Mondays Tuesdays Wednesdays Thursdays Fridays
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
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
If your address is different than the childs please fill out the info below. Otherwise move onto the next sections.
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
Other Information
Does your child have any siblings?
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 class 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.
Please list the people authorized to pick up your child. *
Is there anything else we should know about your child?
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
Pick up:
- Students signed up for other afterschool programs at 4:30 pm will be taken to their next location.
- Dismissal at 5:45 pm
- Students can be picked up from the 92nd Street main exit.
- Staff must be out of the building by 6 pm.
- Late pickups after 6pm incur a $25 charge.
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
Select your Option
prev next ( X )
After school for 1 child $ 1,295.00
$35/day for 37 weeks of after school care for one child.

How many days a week?
Item subtotal: $ 0.00

After school for Siblings $ 1,110.00
$30/day for 37 weeks of after-school care per sibling.Fill out a separate form per child.

How many days a week?
Item subtotal: $ 0.00

Income-based Reduced Rate $ 925.00
$25/day for 37 weeks of after school care per child in family. Fill out a separate form per child. *Must email proof of income/benefits to get this rate.

How many days of the week?
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 more, you can add an additional amount to your final payment.

Total $ 0.00
ATTENTION:

After you submit the application, you will receive a Jotform confirmation with your selections.

*You will get a Quickbooks Invoice within a few days.
- Please pay for at least one full term to secure a space.
- Partial Payments are allowed but total payments are encouraged, it allows me to secure the staff needed to assist.
Preferred methods of payment:

Zelle to busyasabeazer@msn.com

or, Mail a check to:

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

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

If there are technical issues with this form or payment processing, please email Ms. B at info@beazersgarden.com
Should be Empty:

PS 84 EnviroSci-Garden Afterschool Enrichment Registration Form 2022-2023

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Information

Emergency Contact - Other than Parent/Guardian