RLMA - Afterschool 2024-2025

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Student Name* This field is required.
First Name
Last Name
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Choose your school* This field is required.If your child’s school is not listed or your child is 12 years old+, call 561-735-0306 to request additional details
Citrus Cove Elementary
Coral Reef Elementary
Crystal Lakes Elementary
Franklin Academy Elementary
Freedom Shores Elementary
Galaxy Elementary
Hidden Oaks Elementary
Imagine Chancellor Elementary
Lake Worth Christian Elementary
Manatee Elementary
St. Vincent Ferrer School
Unity School
Home Schooled/FL Virtual School K-5th Grade
Drop off
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Grade* This field is required.
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Parent/Guardian Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
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Medical Conditions* This field is required.
Include allergies, medications and important wellness information
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Authorized Pick Up ListPlease include the name of all persons authorized to pick up your child. Please inform authorized parties that they will be required to show ID.
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Registration Payment* This field is required.
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ORDER SUMMARY
Total costUSD
After-care Registration*this payment includes registration, the uniform + t-shirt
$50.00Edit
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Total cost $0.00
Payment Methods
Credit Card
First Name
Last Name
Cash App
After submitting the form, you will be redirected to the Cash App Pay to complete the payment process.
Google Pay
After submitting the form, you will be redirected to the Google Pay to complete the payment process.
Apple Pay
After submitting the form, you will be redirected to the Apple Pay to complete the payment.
ACH Bank Transfer
Account Holder Name
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Terms and Conditions* This field is required.
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Medical Treatment: I hereby give permission for my child to be given CPR and first aid treatment by a qualified staff member of the RLMA, LLC (Raise Leaders Martial Arts) staff. In the event I cannot be contacted, I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I further consent to the disclosure of health information and to the medical, surgical and hospital care treatment and procedures to be performed for my child by a licensed physician or hospital selected by the RLMA, LLC (RaiseLeaders Martial Arts) director when deemed immediately necessary or advisable by the physician to safeguard my child’s health. * This field is required.
I grant permission
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Insurance: I understand that it is my responsibility to provide for my child’s accident and health coverage while participating in these programs and I further understand that RLMA, LLC does not provide this coverage.* This field is required.
I understand
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Payment: I agree to pay my after school program fees before the first day of attending based on the terms of this agreement. I understand that it is my responsibility to bring any billing discrepancies to RLMA, LLC (Raise Leaders Martial Arts) attention within 60 days after they first appear on my financial statements. After 60 days, I waive my right to dispute such discrepancies. I understand that this is a payment plan, broken up into 10 equal payments of $393 deducted each month throughout the school year. I also understand that I am not paying for non-school days, those days have been already been deducted from my tuition cost. I acknowledge that the pandemic has created an uncertain situation and that all payments are non-refundable.* This field is required.
I agree
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Participation: I give permission for my child to participate in all activities and classes at RLMA, LLC (Raise Leaders Martial Arts) and to be transported to Raise Leaders Facility. This form is valid January 1st 2024-January 1st 2026:* This field is required.
I give permission
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Release from Liability and Indemnification: Recognizing that RLMA, LLC (Raise Leaders Martial Arts) will do its best to ensure a safe experience, I understand that accidents may occur from my child’s participation in program activities. I agree to assume these risks. By signing below, I release RLMA, LLC (Raise Leaders Martial Arts), its owners, officers, employees, volunteers, independent contractors, directors and agents from all liability based on any damage, loss, injury or death whether it is the result of ordinary negligence or otherwise, caused to my child or to me from participation in RLMA, LLC (Raise Leaders Martial Arts) programs. I further agree to indemnify and hold RLMA, LLC (Raise Leaders Martial Arts) harmless from all claims that are in any way connected with my child’s participation in this program.* This field is required.
I understand and accept
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By signing this form I understand and agree to all terms and conditions as outlined on this registration form and as stated at raiseleaders.org/terms
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Date* This field is required.
Date
Month
Day
Year
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