2024-25 After School Registration Form

After School Registration Form

August 13th, 2024 - May 23rd, 2025
Please fill all the required fields and we will send you a registration form required by the state to be filled for each child.
Registering for:*

2024-2025 Academic Year
1 - Student's Full Name *

First NameLast Name
2 - Student's Date of Birth *

MonthDayYear
Date of Birth
3 - Current Grade Level*
4 - Start Date*

MonthDayYear
NOTE: Your start day will be moved to the following day if the registration is received after 12:00 PM.
5 - Select your child's school - Other schools' pickup are subjected to confirmation *
School Name*
PARENT INFORMATION
Mother Full Name *

First NameLast Name
Mother Email *
example@example.com
Mother Phone Number*
Please enter a valid phone number.
Father Full Name *

First NameLast Name
Father Email *
example@example.com
Father Phone Number*
Please enter a valid phone number.
Home Address *

Street Address

Street Address Line 2

CityState

Zip Code
PAYMENT

Carefully select your option
IMPORTANT INFORMATION
- The first payment will include a non-refundable $80 Annual Resource Fee per family.
- Payment Frequency: Monthly
- The payments are calculated based on a weekly fee x 36 weeks divided by 10 months.

Choose Your After School Option Below:*

5 Days / week - WITH Pickup - $95 a week5 Day Afterschool 2024-2025

$422.00 for the first month then,$342.00 for each month

3 Days / week - WITH Pickup - $75 a week3 Day Afterschool 2024-2025

$350.00 for the first month then,$270.00 for each month

5 Days / week - NO Pickup - $80 a week5 Day Afterschool 2024-2025

$368.00 for the first month then,$288.00 for each month

3 Days / week - NO Pickup - $60 a week3 Day Afterschool 2024-2025

$296.00 for the first month then,$216.00 for each month

Per Day Option$50 Per Day (plus a non-refundable Annual Resource Fee)

$130.00 for the first day then,$50.00 for each day

Enter coupon

Total

$0.00

Optional Notes for Pick- Ups:
Please include clear, detailed notes for pick-up, if any.
Select your three day options below:*

MondayTuesdayWednesdayThursdayFriday
Select your Per Day option below: *

MonthDayYear
Choose the Date to enroll your child for the day.
Enrollment Agreement

Please review and sign
Signature*

Clear
Date of Consent*

MonthDayYear
Date
How did you hear about us*

FacebookEmailWhatsappInstagramFriendBack to School FairRepresentative calledReceived postcardGEM NewsletterOther
Should be Empty:

After School Registration Form