Before and Afterschool Care Registration

Breath of Life Preparatory Academy
Dear Parents, We are excited to announce that we are able to offer aftercare to our Elementary scholars. The cost of aftercare is $65 weekly and will last from 4:00 - 6:00 PM. It is important that your scholar is picked up on time. At 6:01 you will be charged a late fee of $15. Aftercare tuition is due Friday, the week prior or no later than close of business on Monday. All tuition not made by close of business Monday is subject to unenrollment and a $25 late fee. Please note that families must commit to the full 37 weeks of aftercare services. Aftercare will begin August 7th and run through May 24th.
Scholar Information
First Name*
Last Name*
Grade Attending*
FemaleMale
Birth Date*

MonthDayYear
Doctors Name*

First NameLast Name
Doctors Phone Number*

Area CodePhone Number
Parent/Guardian Information 1
Full Name*

First NameLast Name
Home*

Area CodePhone Number
Cell

Area CodePhone Number
Work

Area CodePhone Number
E-mail*
Parent/Guardian Information 2
Full Name

First NameLast Name
Home

Area CodePhone Number
Cell

Area CodePhone Number
E-mail
Other Infomation
YesNo
If yes please list, including any food or drug allergies.
Does your child have any medical conditions?*
Does your child require any medication? If yes, please list these medications.*
YesNo
Please list the people authorized to pick up your child.*
Emergency Contact - Other than Parent/Guardian
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home*

Area CodePhone Number
Cell

Area CodePhone Number
Work

Area CodePhone Number
All 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.
Should be Empty:

Breath of Life Preparatory Academy

Scholar Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Infomation

Emergency Contact - Other than Parent/Guardian