A-Scholars Enrichment Registration

Expected Start Date:

Date

1st Child Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

FemaleMale

Grade Entering*

Returning or New participant?

New Applicants Only Birth Certificate here*

Browse Files

Required Forms

Does your child have a school physical exam within (6) months or less on file?*

YesNo

Upload Medical Physical Exam here*

Browse Files

All participants must have a school physical on file prior to particapating in program

Does your child have any allergies?*

YesNo

Please list all food allergies.

If more than one child has allergies please include child name and allegies.

Does your child have any medical conditions?

If more than one child has medical conditions please include child name.

List additional outings that interest you?

Field Trips that interest you?*

Roller Skating RinkMovieMuseum

Full Name*

First NameLast Name

Home*

Area CodePhone Number

Cell*

Area CodePhone Number

Work

Area CodePhone Number

E-mail*

example@example.com

Address - Same As Child*

YesNo

Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Full Name

First NameLast Name

Cell

Area CodePhone Number

Home

Area CodePhone Number

Work

Area CodePhone Number

E-mail

example@example.com

Address - Same As Childs

YesNo

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

CityState / Province

Postal / Zip CodeCountry

Full Name

First NameLast Name

Cell

Area CodePhone Number

Home

Area CodePhone Number

Please list the people authorized to pick up your child.

Build you

Winter Break Enrichment$150.00

Join us for Winter Break 2024

Payment Plan Six Week Session 1 (Two Installments)$300.00

Only two installments of $300.00. A non-refundable deposit of $100 is due

Sibling Discount Payment Plan Eight Week Session (Two Installments)$385.00

Only two payments of $385. A $100 NON-Refundable Deposit is due at time of registration.

Sibling Discount Summer Enrichment Eight Week Session 1: June 19th- August 11th$780.00

Enjoy eight full weeks of Summer Enrichment. 8:30-4:30 p.m. This package Includes: Registration Fee Daily meals (Breakfast & Lunch) T-shirt Reading & Math Summer Bridge Program (Keep the brain sharp for the summer) Sports: Soccer, Basketball, Biking, Team Building Games, Kickball, Double Dutch, STEM Challenges, Arts & crafts, sewing, crochet, printing, journaling, poem writing, Young Authors Club, & ChessNot Included: Gymnastics, Swimming, Golf, Tutoring, Horse-riding are Alacarte

Before or After One Flat Rate Per Week$150.00

3 or more days per week. Must be enrolled in a summer package. 7:30 a.m-5:00p.m.

DROP-IN WEEK$125.00

ONE WEEK OF SUMMER ENRICHMENT

Quantity

Registraion Activity Fee$115.00

Non Refundable: Includes. Field trips (excluding Urban Air) T-shirt, supplies, meals, sports/ recreational equipment (Soccer, tennis, basketball, kickball, volleyball)

Quantity

Enter coupon

Total $0.00

Do any of these special activities interest you?

Who referred you to our program*

Rules & Policies:*

Yes, I understand that my child may be required to wear a mask for all indoor activities daily and must adhere to all safety guidelines.Yes, I understand that my child/ren will need a water bottle daily.Yes, I understand that my child/ren MUST bring gym shoes for everyday sports and activities. An additional pair of indoor shoes are required to help cut down the spread of germs.Yes, I understand that my child/ren MUST attend A-Scholars enrichment in good health. If any symptoms are present, the participant will be isolated, and a parent will be called to take the participant home. Due to COVID-19 a doctor's note and or negative COVID test MUST be received before participants can to return. As stated in Anointed Scholars Inc. Policy and Procedures.Yes, I understand before start date all participants must have an negative COVID-19 test on file.I understand that all registration, supply fees, special activities must be paid prior to start date.

I am the legal parent /guardian and I give permission for my child to participate in all activities given. I release Anointed Scholars to take photograph, videotape and digital record during regular program hours. Though the names of faculty, staff, and administration can be used, it is our policy that full names of participants will not. Occasionally it might be necessary to use the first name but never the last name, address, or phone number of participant.*

Yes, I consentNo, I do not consent

I have read, and fully understand all policy and procedures and adhere to all Anointed Scholars Policies as it relates to COVID-19 and Anointed Scholars Program Policy. If I registered via fax or on-line my e-signature will have the same legal entitlement (Please READ our program policy)*

Yes

COVID-19 Protocol

Anointed Scholars Inc. COVID-19 Plan/Protocols
Updated as of 6/4/21

Anointed Scholars Inc. in-person programming will be operated in accordance with applicable guidance from the Centers for Disease Control and Prevention (CDC), Illinois Department of Public Health (IDPH), and Chicago Department of Public Health (CDPH).

Centers for Disease Control and Prevention (cdc.gov)

Group Sizes
Anointed Scholars Inc. will operate in-person programming with participants in small groups.

Group(s) will be limited to no more than 20 individuals between the ages of 6-12
Staff to participant ratios for 6-12 year olds 1:15
Outdoor programming will be prioritized
Group members will become stable cohorts that will remain together for the duration of the programming season without new members being added
Social Distancing
Group may interact within 6 feet of distance in some circumstances, provided all participants are wearing a proper face covering.

Face Coverings/Masks
All participants and staff will be required to wear face coverings that cover both their nose and mouth at all times. Participants will need to bring their own face coverings that may be comfortably worn throughout the day.

Hygiene Requirements
Anointed Scholars Inc. will follow the CDPH hygiene guidance to promote a healthy environment for staff and participants. Participants and staff will be required to wash their hands with soap and water or use hand sanitizer regularly.
Daily Drop Off/Pick Up
It is advised to modify our drop off and pick up procedures. The following options include: Curbside/Parking Lot or Outdoor.

Self-Screening Checklist

Staff and participants are encouraged to self-monitor for symptoms of COVID-19 and stay home if they feel sick. Staff and participants should also stay home if they have been in close contact with someone who has been diagnosed with COVID-19 within the past 14 days. Prior to entering the facility all staff, patrons and participants will be asked to Self-Screen (parents are responsible for self-screening child(ren) by asking themselves the following questions each day:

Have you had a body temperature over 100 degrees Fahrenheit or have you used a fever reducer in the previous 24 hours to treat a body temperature over 100 degrees Fahrenheit?
Do you have a new cough that you cannot attribute to another health condition?
Do you have a new shortness of breath that you cannot attribute to another health condition?
Have you recently developed a complete loss of smell or taste?

Illness-COVID-19 Specific
In the event that it has been reported that a confirmed case of COVID-19 park staff will do the following, immediately:

Staff will call Risk Management and document
Parent will be notified
Child will be separated from pod and taken to the “Isolation Zone”
Area where child was will be cleaned and disinfected

Vaccinated Participants must adhere to the same policy and procedures set in place by Anointed Scholars Inc.

All payments are Non-Refundable

Phone: 1-312-798-9046 Email:ascholarsinc@gmail.com

Signature

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Anointed Scholars Inc. Enrichment Registration

Child Information

Medical, Allergies, Document Upload

Parent/Guardian Information 1

Parent/Guardian Information 2

Emergency Contact - Other than Parent/Guardian

Select a Package below!

Special Activities

Anointed Scholars Policy