EATS After School Program Enrollment Form

Enriching Academically Talented Students Enrollment Application

2023-2024 School Year
E.A.T.S. After School is pleased to offer our After School Program for those families that need extended care for their children beyond the bell of school dismissal.

We look forward to providing an enriching academic program for your child/children. Thank you for entrusting us with your child. Please fill out the application form completely. Your child will not be enrolled in the Program until your paid registration and application are submitted.

Parent Orientation for your school will be announced via email & school announcement before

Fall Session: COMPLETED

Winter Session II: January 2nd - March 31st, 2024

Spring Session III: April 1st - June 26th, 2024

New Registration 2024--- Special Rate $150.00

(The registration fee is non-refundable, $60 + The first week of after-school, $90)

Please complete and submit one form per student enrolled in the EATS Program. There is a $10 sibling discount—special monthly pricing for multiple siblings.
Student's Name*

First NameLast Name
Parent's Name Mom*

First NameLast Name
Parent's Phone Number Mom*
Cell phone and reachable
Parent's Name Dad*

First NameLast Name
Parent's Phone Number Dad*
Cell phone and reachable
Parent's Email Mom*
example@example.com
Parent's Email Dad*
example@example.com
What grade is your child entering in September 2023?

Pre KKindergertan1st Grade2nd Grade3rd Grade4th Grade5Th GradeMiddle SchoolOnline Academy
What school does your child attend?*

PS 181QPS 35QHomeschoolOnline Athlete Academy
Effective date for enrollment agreement in After School Program*

MonthDayYear
Please enter your start date, Choose any Monday ex: enter 09-18-2023 or 10-02-2023
Childs Birthday*

MonthDayYear
follow date format
Child's Shirt Size
Please note any known allergies or health concerns: There will be an opportunity to fill out complete health forms or give copies of what was submitted to the school. ex: epi pen, nut allergy, etc
Please inform us if your child has an IEP and how to best help:
Please specify each person authorized with permission to pick up your child from the EATS After School Program.
Authorized Person 1:

First NameLast Name
Phone Number 1:
Authorized Person 2:

First NameLast Name
Phone Number 2:
Authorized Person 3:

First NameLast Name
Phone Number 3:
Please specify who does NOT, have authorization or permission to pick up your child from the EATS After School Program.
Non-Authorized Person 1:

First NameLast Name
Phone Number 1:
Non-Authorized Person 2:

First NameLast Name
Phone Number 2:
Statement of Fees
Please check the After School Program enrollment option desired for your child: Not due at registration*

Weekly Only ($90)Monthly ( $350)Session Only (3-month contract rate of $1,050)All Sessions Fall, Winter, Spring (annual contract rate of $3,150)Drop-in rate of $25 per day ( package of 3 days plus registration $125)
Statement of Policy
- An Enrollment Form is required for all students participating in this program.
- Tuition will be billed via invoice after registration. September is registration, orientation, and fundraising. Drop-in charges and late fees are paid upfront. Payments are due upon receipt. A late monthly cost of $35 is applied after the 5th day of the month on all accounts past due. Delinquent accounts will result in the dismissal of a student from the After School Program. Please note that enrollment changes can only be made in October & January of each year.
- The After School Program ends promptly at 6:00 p.m. After 6:00 p.m., a late charge will be added at $10.00 for each 10-minute interval or fraction thereof.
- Students may participate on a drop-in basis with prior notification from parents. If an Enrollment Form has not been previously submitted, you will be sent an email with the link to complete and submit it.
- Only persons authorized by the parent or guardian may pick up your child from the EATS After School program. Please notify the Directors in writing if anyone other than a parent/guardian will pick up your child.
- All EATS After School Program students must follow all school and program rules. Behavioral problems will result in parent notification, mediation, and possible suspension from the program.
- Students with a fever or contagious illness may not participate in the program. If your child is sick, please keep them home.
- You will receive the EATS Parent agreement and program policies during orientation.
I have read and understand the Statement of Fees and Statement of Policy contained here.*

Agree
I give EATS Program permission to charge my card for my child's tuition account for the EATS After School Program services indicated on this Enrollment Form, according to the Statement of Fees once invoicing starts in September .*

Agree
Signature

Clear
Registration / Tuition: The registration box has to be submitted. Other payment squares are optional.
prevnext( X )
RegistrationFirst week of program & nonrefundable registration fee and
$150.00 Registration for 1 child & Registration w/ Sibling discount & Drop In Registration
Item subtotal:$0.00



Annual Tuition (1 child)October 2023 - June 2024 EATS Elite Parents or Sponsor a Child Afterschool
$3,150.00 Quantity



Drop In Service - 3 Pack (1 per child)USE REGISTRATION TAB- CHOOSE $125 Package of 3 days plus registration. Use through the sessions/year. Once three days are used, you will be billed.
$1.00



Total

$0.00

Payment Methods

Debit or Credit Card

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

Should be Empty:

Enriching Academically Talented Students Enrollment Application

Statement of Fees

Statement of Policy