After School Program Registration

New Family - T Elite ASC Registration

If you need any assisting completing this form, please contact us at: 224-318-7945
The following is required for all students requiring care for either After school program, a day off from school, or any of our camps, per DCFS.
Number of Children Registering*
If you have more than 1 child: You will need to submit separate school, medical, and class registration details below for each child. Please complete all child in the family on one form so multi-sibling discounts apply correctly.
- 1st Parent/Guardian Last Name*
- 1st Parent/Guardian First Name*
- 1st Parent/Guardian Relationship*
- 1st Parent/Guardian Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- 1st Parent/Guardian Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- 1st Parent/Guardian Email*
  example@example.com
- 2nd Parent/Guardian Last Name
- 2nd Parent/Guardian First Name
- 2nd Parent/Guardian Relationship
- 2nd Parent/Guardian Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- 2nd Parent/Guardian Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- 2nd Parent/Guardian Email
- 2nd Parent/Guardian Email
  example@example.com
- Emergency Contact First & Last Name*
- Emergency Contact Relationship*
- Emergency Contact Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- You will be asked about attendance registration for each individual child.
- Name (Primary Child)*
  
  First NameLast Name
- Gender/Sex*
- Date of Birth*
  
  MonthDayYear
  Date
- Primary Child's Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Grade*
- School of Attendance Name
  *For After School Care Registration Only
- MonTuesWedThursFri
- YesNoUnsure
- Medical Information
  
  In the event that a medical emergency arises and both parents/guardians can not be reached or the listed emergency contact, and your child requires medical addition, we will get your child immediately to medial care. As such, the following medical information will assist us in properly caring for your child. All information will be kept on file and information protect for confidentiality.
- Please describe any allergies or medical information we need to be aware of to care for your child.
- If your child requires any prescription medication to be take, please list these here. A doctor's note, as well as explicit instructions on use, will be required before we can have medication in our facility and administer it.
- If you are unable to provide the following listed below now, please have this available by the first day of attendance or prior.
- Please upload the most recent copy or your Child's Physical Form. A new physical is not needed for our registration. The current physical on file at your child's school is sufficient. This assist us in ensuring we are not only providing the best care, but your child is cleared for physical activities we will have during our after school program.
  
  Cancelof
- Copy of Medical Insurance Card
  
  Cancelof
- Primary Doctor's First & Last Name
- Primary Medical Group/Hospital Group
- I am the legal parent/guardian of the child indicated aboveIf emergency medical care is needed and I am unavailable, I authorize the supervising teacher or staff member to seek medical treatment for my child.
- I, the undersigned, agree with the following statements (check those that apply)
- Signature Acknowledgement for First Child*
- Name (2nd Child)
  
  First NameLast Name
- Gender/Sex
- Date of Birth
  
  MonthDayYear
  Date
- 2nd Child's Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Grade
- School of Attendance Name
  *For After School Care Registration Only
- MonTuesWedThursFri
- YesNoUnsure
- Medical Information
  
  In the event that a medical emergency arises and both parents/guardians can not be reached or the listed emergency contact, and your child requires medical addition, we will get your child immediately to medial care. As such, the following medical information will assist us in properly caring for your child. All information will be kept on file and information protect for confidentiality.
- Please describe any allergies or medical information we need to be aware of to care for your child.
- If your child requires any prescription medication to be take, please list these here. A doctor's note, as well as explicit instructions on use, will be required before we can have medication in our facility and administer it.
- If you are unable to provide the following listed below now, please have this available by the first day of attendance or prior.
- Please upload the most recent copy or your Child's Physical Form. A new physical is not needed for our registration. The current physical on file at your child's school is sufficient. This assist us in ensuring we are not only providing the best care, but your child is cleared for physical activities we will have during our after school program.
  
  Cancelof
- Copy of Medical Insurance Card
  
  Cancelof
- Primary Doctor's Office Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Primary Medical Group/Hospital Group
- I am the legal parent/guardian of the child indicated aboveIf emergency medical care is needed and I am unavailable, I authorize the supervising teacher or staff member to seek medical treatment for my child.
- Signature Acknowledgement for Second Child
- Name (3rd Child)
  
  First NameLast Name
- Gender/Sex
- Date of Birth
  
  MonthDayYear
  Date
- 2nd Child's Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Grade
- School of Attendance Name
  *For After School Care Registration Only
- MonTuesWedThursFri
- YesNoUnsure
- Medical Information
  
  In the event that a medical emergency arises and both parents/guardians can not be reached or the listed emergency contact, and your child requires medical addition, we will get your child immediately to medial care. As such, the following medical information will assist us in properly caring for your child. All information will be kept on file and information protect for confidentiality.
- Please describe any allergies or medical information we need to be aware of to care for your child.
- If your child requires any prescription medication to be take, please list these here. A doctor's note, as well as explicit instructions on use, will be required before we can have medication in our facility and administer it.
- If you are unable to provide the following listed below now, please have this available by the first day of attendance or prior.
- Please upload the most recent copy or your Child's Physical Form. A new physical is not needed for our registration. The current physical on file at your child's school is sufficient. This assist us in ensuring we are not only providing the best care, but your child is cleared for physical activities we will have during our after school program.
  
  Cancelof
- Copy of Medical Insurance Card
  
  Cancelof
- Primary Doctor's First & Last Name
- Primary Doctor's Office Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Primary Medical Group/Hospital Group
- I am the legal parent/guardian of the child indicated aboveIf emergency medical care is needed and I am unavailable, I authorize the supervising teacher or staff member to seek medical treatment for my child.
- Signature Acknowledgement for Third Child
- After-School Program Tuition & Pricing
  
  We have after-school care for students with or without Karate.
  
  CCAP is accepted and would cover karate classes (uniform and gear are separate).
  
  Payment Agreement
  
  As part of our tuition, students will have a minimum of 2 Martial Arts classes each week.
  
  The following Tuition Options are available to you:
  
  FULL-TIME STUDENTS WITH KARATE
  - Weekly: Tuition $150 each week paid the Friday prior
  - Monthly: Tuition $549 per month paid on the last Friday of each month
    
    Monthly families receive priority enrollment for camps and school break programs.
  FULL-TIME STUDENTS WITHOUT KARATE
  - Weekly: Tuition $115 each week paid the Friday prior
  - Monthly: Tuition $389 per month paid on the last Friday of each month
  PART-TIME STUDENTS WITH KARATE
  - 3x a week $110 paid each week on the Friday prior
  - 2x a week $90 paid each week on the Friday prior
  Monthly Option:
  - 3x per week $399 per month
  - 2x per week $329 per month
  No additional discounts for monthly payment options for part-time students.
  
  Discounts are voided if payments are not paid the Friday prior to the billing cycle selected.
  
  June weekly tuition will be calculated based on the last weekly rate plan a family has paid for.
  
  CCAP Families:
  - All co-pays are due on the first of the month.
  - Students must maintain an 80% attendance rate to remain enrolled in the after-school program.
  - Students are not required to also be enrolled in Karate classes. Families must give a 2-week notice if no longer taking karate classes.
  EARLY RELEASE & NON-ATTENDANCE SCHOOL DAYS
  
  Early release days (up to 1 hour early) and half days are included in regular tuition and do not require additional fees.
  
  When students have a scheduled full-day off from school, additional care is available.
  
  Families must notify staff at least 2 business days prior if their child will attend.
  - $25 for full-day care
  Winter Break and Spring Break programs are offered separately and may include:
  
  Martial arts intensive training
  Morning Kata training
  Afternoon Kumite training
  At least one field trip
  Additional pricing for seasonal camps will be communicated in advance.
  
  **CCAP families may be responsible for an additional field trip and lunch fee on a full day off of school care (usually between 10-15 per child).
  
  In an effort to keep our tuition low and our focus and dedication on our students, we have adopted automatic credit card payments for all weekly tuition. Payments will be processed weekly, at the end of every week. If you elect not to have automatic payments, tuition must be provided each Friday by 6:00 p.m. All payment accounts are processed through our Management Software. Families are encouraged to keep a credit card on file for automatic payment withdrawals. We also accept Cash payments.
  
  Late Fees
  
  All students must be picked up by 6:00 p.m. unless unusual circumstances or extreme weather conditions affecting all families. A late charge of $5 for every 5 minutes late will be accessed via invoice.
  
  Payments received after Friday each week will be accessed a $10 late payment charge which will be invoiced.
  
  Credit Card authorizations that are declined will be assessed a maximum of $25 return payment fee which will be invoiced.
  
  If any changes are made to payment policies, parents will be notified via email. Tuition rates are locked in for the school year and will be reassessed, as necessary at the end of each school year.
- A T Elite member will contact you to complete your registration and welcome you aboard!
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New Family - T Elite ASC Registration

You will be asked about attendance registration for each individual child.

Medical Information

I, the undersigned, agree with the following statements (check those that apply)

Medical Information

Medical Information