2020/2021 After School Karate Registration

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least two person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the Skillz 4 Kidz Location and be able to take responsibility for the child in case the parent/guardian cannot be contacted and must be at least 18 years of age. Please note in case of an emergency where you cannot be contacted, we will start with Contact #1 and then move down.
Emergency Contact & Authorized Pick-Up #1
Full Name*

First NameLast Name
Primary Phone Number*
Secondary Phone Number
Relationship to Child*
I am certifying that Emergency Contact/Authorized Pickup #1 is at least 18 years old*
Type initials above to consent
Emergency Contact & Authorized Pick-Up #2
Full Name*

First NameLast Name
Primary Phone Number*
Secondary Phone Number
Relationship to Child*
I am certifying that Emergency Contact/Authorized Pickup #2 is at least 18 years old*
Type initials above to consent
Authorized Pick-Up #3
Full Name

First NameLast Name
Primary Phone Number
Relationship to Child
Authorized Pick-Up #4
Full Name

First NameLast Name
Primary Phone Number
Relationship to Child
Authorized Pick-Up #5
Full Name

First NameLast Name
Primary Phone Number
Relationship to Child
AUTHORIZED PICK UP POLICY: Only the people listed above may pick up your child from after school. No exceptions are made for family members without advanced written notice prior to pick up. Anyone that needs to be added for emergency reasons - we MUST receive a text from a parent phone number on file to 336-270-6825 or an email from a parent email on file to teamskillz@skillz4kidz.com. Phone call only is not allowed - you may call first and then text or email but we MUST have the text or email.*
Type initials above to consent
Please provide the names of persons who are UNAUTHORIZED to pick up your child: (These people are specifically NOT allowed to pick up your after schooler). If anyone is not allowed due to a court order - please provide a copy of the court order. Please type N/A if not applicable*
List the FIRST and LAST names of all persons unauthorized to pick up your child.

Classes, Snacks, Payment, Policies & Procedures

Fitness & You, LLC; Fitness & You II, both d.b.a. Skillz 4 Kidz
MARTIAL ARTS CLASSES: Students will participate in curriculum martial arts classes 2 Days per week and a Martial Arts Uniform is required. Parents will receive a calendar with dates for all martial arts tests for planning and budgeting purposes. For those who choose for their children to receive new belts and learn new curriculum - students must test to do so. Each testing is $50 and includes a new belt, a board to break, and a special certificate. We will begin announcing testing as well approximately 6 weeks in advance of testing.*
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SNACKS: It is suggested that each child bring a healthy snack each day. We do not provide or have for purchase snacks or drinks of any type with the exception of a bottle of water for $1 each. Each child typically likes to drink a lot of water while playing the active games so please try to send a bottle of water each day or a refillable water bottle that can be filled from our water cooler (we do not have cups to use for water) *
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PICK UP: All scheduled activities will end at 5:00pm and will transition to quite activities awaiting pickup by 6pm. We understand that you may encounter emergencies or unforeseen traffic problems, and we will attempt to work with you when that happens. If you are going to be late, please call us as soon as you know. If you are consistently late, Skillz 4 Kidz will inform you that we are going to charge a $10 late fee for every 15 minutes. Consistently late is once per week for 2 or more weeks. If you ever need anyone not on your pickup list to pickup your child you must either text or email us (from the phone or email we have on file for you) the name of the person who will be picking up, their contact phone number, and please inform that person that a license is required for ID purposes. INCLEMENT WEATHER - If ABSS closes due to Inclement Weather - we will be unable to pickup your child. We will be closed if ABSS closes. We will contact everyone through the Facebook Families Page, Email, and Text message. PLEASE NOTE WE OPERATE ON ABSS SCHEDULE - IF ABSS CLOSES WE CLOSE. IF YOUR CHILD ATTENDS A CHARTER OR PRIVATE SCHOOL, PLEASE NOTE WE ARE ON ABSS SCHEDULE - WE DO NOT ALTER DAYS OF OPERATION, PICK-UP, ETC FOR CHARTER OR PRIVATE SCHOOLS. *
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PAYMENT POLICIES: All payments are due previous to services being provided. Please understand that our tuition is based on a yearly school calendar with 39 instructional weeks. As a result, our tuition is calculated based on a rate of Teacher Workdays, 2 Holiday Camps, (Veterans Day and Martin Luther King Jr Day), 1 Week of Holiday Break and Spring Break, and 39 weeks of after school services - then divided equally over all weeks of school (42 weeks from 1st day of school to last day of school) to provide you with a consistent monthly ($396.66), bi-weekly $169.98) , or weekly ($84.99) rate. Rather than charge you with varying tuition payments, we prefer to charge you the same base rate monthly, bi-weekly, or weekly that includes all services. ****There is a $10/week sibling discount**** There will be a $35 service charge for any returned checks or E-checks (EFT/ACH) payments. If your payment will not authorize we will notify you, and you will have 48 hours from our notice to bring us full payment. If you fail to do so, your child's program will be suspended and we will no longer pick up your child *There are no refunds for days missed for illness, appointments, extra curricular activities, weather closings, etc. Charges are charged for each week, bi-weekly, or monthly during the school year - Bi-Weekly or Monthly charges are pro-rated at the beginning or ending of the school year as necessary. All Monthly charges are due on the 1st of the month *
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REGISTRATION: The registration fee is per child and is non-refundable.*
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Please note that Skillz 4 Kidz is an After School Program and not a licensed Day Care Facility.*
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CANCELLATION: There is a 14 day cancellation policy. You must provide cancellation in writing via email to teamskillz@skillz4kidz.com or text to 336-270-6825. The 14 days will collected upon receipt of the cancellation using the card on file unless other arrangements are requested or payment has already been paid - The 14 days begins the Monday after receipt of notice unless a later date is requested. If the 14 days ($169.98 1 child - more for additional children) does not process - we will continue to try processing the payment until received. We WILL NOT accept any cancellation verbally - you must text or email your cancellation request to prevent any misunderstanding.*
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TUITION INCLUDES : Teacher Workdays (ABSS ONLY) 7:15am - 6:00pm; Early Release Days (ABSS ONLY); 1 Full Week of Holiday Break Monday-Friday 7:15am - 6:00pm (During the ABSS Break); Spring Break Week according to ABSS Schedule Tuesday - Friday 7:15am - 6:00pm; Veterans Day & Martin Luther King Jr Day (any school that is closed can attend). *We only offer Teacher Workdays for ABSS - we are not open for teacher workdays for other schools. **We are CLOSED: Monday Sept 6 for Labor Day; Wednesday November 23 - Sunday November 27 for Thanksgiving Holidays; Tuesday December 20 - Monday December 26 for Christmas Holidays; Friday April 7 and Monday April 10 for Easter Holidays; The last day of school is Friday June 9 - for those transitioning to summer camp you can register early to secure a space for camp that will begin Monday June 12 (you can choose the weeks you want) as we did get full for 2022 Summer Camp*
Type initials above to consent
How many days per week do you need for After School>*

5 Days3 Days (must be same 3 days each week)2 Days (must be the same 2 days each week)
For 2 day or 3 day options - please list the days you are requesting:
What schedule would you like? *Please note that the 1st week and last week of school are included in monthly options *Please note there are NO REFUNDS FOR ANY REASON for a Paid in Full option. Bi - Weekly $169.98 ($319.96 2 kids)- 5 Days; $139.98 ($259.96 2 kids) - 3 Days; $119.98 ($219.96 2 kids) Weekly $$84.99 ($159.98 2 kids) - 5 Days; $69.99 ($129.98 2 kids) - 3 Days; $59.99 ($109.98 2 kids) - 2 Days Monthly $373.24 ($746.61 2 kids) - 5 days; $307.95 ($606.57 2 kids) - 3 Days; $263.95 ($513.24 2 kids) - 2 Days*

Bi-WeeklyWeeklyMonthly
Please list below any Coupon Codes:
type Above any Coupon Codes
DAYS / HOURS OF OPERATION: Skillz 4 Kidz After School program will follow the ABSS Calendar and provide services on FULL and HALF days. Skillz 4 Kidz After School program will NOT operate on school holidays. Contact facility for camp details. You will be provided a Holiday Schedule*
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DISCIPLINE POLICY: In an effort to provide your child and other students with a safe and fun experience, it is neccessary that all students exhibit proper behavior, self-discipline and self-control. Correcting unsatisfactory behavior is time consuming and distracts from providing quality, safe, educational, and fun activities for the rest of the students. If we are unable to control a situation, we will contact the parents first by telephone at or near the disturbance and/or write a report that is given at checkout, so that the parent may reinforce the requirement that all students enrolled in the After School program behave satisfactory and follow instructions fully and promptly. Students that cannot by controlled by verbal commands or that are a constant disciplinary problem will be suspended from the program(s). Actions that can lead to suspension - constant disciplinary problems - assaulting in any manner staff or another child - cursing at staff or another child - refusing to follow directions. *
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WAVIER & RELEASE: I (Parent or Guardian) understands that Student(s) is engaging in physical activity, along with the use of Skillz 4 Kidz's facilities, equipment, training and instruction, which can be dangerous and could cause injury. Therefore Buyer(s) assumes all risk of injury to said Student(s). Buyer(s) / Student(s) and all friends/family members hereby waives and releases any claim or right and holds harmless from suing Skillz 4 Kidz, its employees or agents for injury. Buyer(s) has carefully read this waiver & release and fully understands that it releases Skillz 4 Kidz of all liabilities for any injury that may occur. It is always advisable to consult your physician before undertaking a physical activity program, particularly those performed at Skillz 4 Kidz. .*
Type initials above to consent
PICTURES: As the Parent, Guardian of the student I hereby grant and authorize Skillz 4 Kidz the right to take, edit, copy, publish, distribute and make use of any and all photos or video taken of my child(ren) to be used in and/or for legally promotional materials and digital communications. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of and will not be returned. Skillz 4 Kidz takes pictures during our After School and may use these pictures on the Families Facebook Page for parents to see and/or in any other marketing material. These pictures are property of Skillz 4 Kidz and no monetary or other compensation will be provided for use of the pictures.*
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LOSS/DAMAGE/THEFT: Skillz 4 Kidz does not assume any responsibility for the loss, damage, or theft of any property belonging to the Buyer(s), Parent, Guardian/Student(s) and I agree by initialing that Skillz 4 Kidz and its personnel are not responsible or liable for any such property in the event of loss, damage, or theft on or about the facility. We specifically ask that children NOT bring any electronic devices or any items of value. Any electronic devices will be taken and given back to the student at checkout.*
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ELECTRONICS/TECHNOLOGY POLICY: Skillz 4 Kidz does not allow electronics of any kind - including smart watches, video games, cell phones, etc to be used at our facility. If students take these items out during After School, they will be taken and returned at check out. If a student is required to do homework on a laptop - the child must show his/her homework assignment from the teacher to our after school staff, bring his/her own laptop (wi-fi only enabled if homework requires internet use - otherwise staff will ask that it be turned off during use - if internet use required staff cannot monitor only one student so will not be responsible if your child enters an inappropriate area on the internet, however, we will monitor as much as possible. If you child is caught using an inappropriate area of the internet, that child will not be allowed to use the laptop for any homework at all - no exceptions.*
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TRANSPORTATION RELEASE: I (parent or guardian) give my consent to Skillz 4 Kidz, its officers, agents, employees, individuals associated with the organization to transport my child(ren) named above to and from the authorized activities and events as well as daily from the specified school to the Skillz 4 Kidz Facility. If I want my child in a certain type of child restraint, I must notify Skillz 4 Kidz and leave the child restraint for them to use - otherwise Skillz 4 Kidz booster seats are used except on the bus.*
Type initials above to consent
*Trade In Stock: I understand that Skillz 4 Kidz is a Martial Arts Facility and not a daycare in as such, their stock-in-trade is not supervision and care. The supervision and care of children is incidental t their participating in the program and that Skillz 4 Kidz i snot assuming responsibility or the provision of daily childcare outside of the program - after school, summer camp, or martial arts classes (we do not operate a daycare program). The intent of Skillz 4 Kidz is to teach Martial Arts physical and philosophical character building skills.*
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EXTRA CHARGES: I acknowledge that belt testing, safety equipment, weapons, camps, tournaments, parents night out events and seminars are not included in after school fees. You wil be notified at any point that your child needs anything. Additionally, you agree to purchase ONLY Skillz 4 Kidz authorized safety equipment, uniforms and weapons for use in the program*
Type initials above to consent
Sign Document*
Date Signed*

MonthDayYear
Special notes and/or instructions for staff:

2021 / 2022 Parent Transportation Responsibility Checklist
I, parent or legal guardian, authorize my child to be picked up by an Skillz 4 Kidz designated vehicle and I understand that it is my responsibility to do the following:
1. Notify my child's school teacher(s) that he/she will be riding with Skillz 4 Kidz and the days they will be pick up by Skillz 4 Kidz.*
Type initials above to consent
2. Notify my school's office, confirming my child should be in line for Skillz 4 Kidz and that Skillz 4 Kidz is listed as an authorized pick up for after school as well as early release for my child.*
Type initials above to consent
3. Text Skillz 4 Kidz at (336) 270-6825, or at teamskillz@skillz4kidz.com if my child will not be at school that day. Please note that it makes us late to other schools if we have to wait to verify that your child is not at school. PLEASE NOTE THERE IS AN AUTOMATIC $10 NO SHOW FEE IF YOUR CHILD IS NOT AT SCHOOL AND YOU DID NOT TEXT OR EMAIL. ONLY TEXT AND EMAIL IS ACCEPTED TO INFORM US OF NO NEED TO PICK UP*
Type initials above to consent
4. Responsibility for your child boarding the Skillz 4 Kidz vehicle lies solely with the school and/or teacher. Our responsiblity begins when your child boards the designated vehicle.*
Type initials above to consent
Sign Document*
Should be Empty:

2022/2023 Skillz 4 Kidz After School Program

Registration Fee - $199 includes a Free Martial Arts Uniform. There is a place at checkout to enter any coupon codes or offers

Student & School Information

Select Date for After School Services to Begin:

Parent Information

Emergency Contacts/Authorized Pickup

Medical / Health Information

Medication

Medical Release & Transportation Consent

Classes, Snacks, Payment, Policies & Procedures

2021 / 2022 Parent Transportation Responsibility Checklist