2018-2019 Preschool Registration

Thank you for registering your child in ATC K-1st Summer Review. This form is needed for each student. If you are registering a sibling, please complete the form a second time.

If you have questions, please contact the office at 614-890-3985 or atcoffice@atcacdemy.org.
All the Children of the World Academy

2023 K-1st Summer Review Registration
PLEASE NOTE: SUMMER REVIEW SESSION 2 IS FULL
Student's Name*

First NameLast Name
Gender*

MaleFemale
Student's Birth Date*

MonthDayYear
Parent 1 Name*

First NameLast Name
Cell Phone*
Email*
example@example.com
Parent 2 Name*

First NameLast Name
Cell Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My family is a*

2022/23 ATC familyNOT a 2022/23 ATC family
Name of 2022/23 teacher*

Mrs. CornettMrs. GattoMrs. SeymourMrs. Wuersig
Session Choice*

Session 1 June 6,8,13,15,20,22 $150
Number of Sessions chosen*
There is a $50 non refundable deposit for EACH session. The deposit applies to the cost of each session and is DUE AT THE TIME OF REGISTRATION. Sessions must be PAID IN FULL BY MAY 23.
Health Record
Does your child have any food, medication or environmental allergies?*

YesNo
Check all that apply*

FoodMedicationEnvironmental
List and explain*
Does your child's allergy/allergies require ATC staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child (such as Benedryl, EPI Pen, or inhaler)?
Choose all that apply*

EPI PenInhalerNoneOther
Staff intervention*

YesNo
If staff intervention is required, a "Request for Medication" form must be turned into the ATC office. ATC has Request for Medication forms for current students who have attended the 2022-2023 school year. If you are a past/new family or if this is a new request for a current 2022-2023 student, please click on Request for Medication above to download it or print it from the website.
Does your child have a special health or medical condition?*

NoOther
Is your child currently using any medication, food supplement or medical food (such as electrolyte solution)?*

NoOther
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?*

NoOther
List any other health information that would help us care for your child.
Authorized for Pick-up
Please list the names of all persons that have permission to pick up your child from K-1st Summer Review (including parents, grandparents, neighbors, etc.) in the text box below. These authorized adults will need to show a photo ID to pick up your child.

To indicate that your child may only be picked up by his/her parent please type "Parent Only" and list their names.
Authorized for Pick-up*
Please type your name below to indicate your signature:
Electronic Signature*
ATC K-1st Summer Review Registration Fee Payment
I attest that the information on this K-1st Summer Review Registration Form is true and accurate. I understand that a non-refundable registration fee of $50 per student, per session must be submitted by check or online (below) for the registration process to be complete.
Check the box to confirm the statement above.*

I agree
Minimum due with registration ($50 per session)
TOTAL due by May 23 (includes deposit of $50 per session)
You may pay online below with a bank transfer, credit/debit card, OR pay in person with cash or a check.

How would you like to submit the $50 non-refundable deposit fee due for each student/session?

NOTE: You will be charged a 3% convenience fee for card transactions and a 1.5% convenience fee for bank transfers by the online payment company for this service.
Payment Options*

Pay online with a bank transferPay online with a credit/debit cardPay by check or cashOther

All the Children of the World Academy

Health Record

Authorized for Pick-up

ATC K-1st Summer Review Registration Fee Payment