2024-25 Thales Academy After School Registration Form

After School Care Registration (2026-2027)

Please fill out a separate form for each child.
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Grade
Are there any other siblings enrolled in Thales Academy?

Parent/Guardian Information
Parent/Guardian 1's Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Parent/Guardian 2's Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number

Emergency Contact
Contact 1's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Contact 2's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number

Medical Information
Physician's Name

First NameLast Name
Phone Number

Area CodePhone Number
List any medical conditions that the after school program should be aware of in the space below.
Does your child have medication in the office?

Release Information
Please provide information for any adult in addition to the parents who is approved to pick up your child. The ASC staff will ask for a picture ID when signing your child out.

The following person(s) ARE allowed to pick up my child:
Allowed Name

First NameLast Name
Allowed Name

First NameLast Name
Allowed Name

First NameLast Name
If there is anyone who is specifically NOT allowed to pick up your child (due to custody or safety issues), please provide that information below. The safety of your child is our number one priority. Thank you for your cooperation in this matter.
Not Allowed Name

First NameLast Name
Not Allowed Name

First NameLast Name

Photo Release

To keep you updated on your child’s after school care, we send out emails including photographs of the classroom as well as posting activities on the Thales Academy website. Please fill out the following release form.
I grant Thales Academy the right to take photographs of my child. I authorize Thales Academy, its assigns, and transferees to copyright, use, and publish the same in print and/or electronically. I agree that Thales Academy may use such photographs of my child.
Signature:

Waiver
I, the undersigned hereby acknowledge that I am aware of the nature of this activity. My child is voluntarily participating in the Thales Academy After School Program and any activities offered. I will provide any transportation to and from The Thales Academy and assume all risk of injury that might result to my child. I hereby consent to hold The Thales Academy After School Care Program and all of its staff members or agents free from any and all liability, claims, and other actions whatsoever arising from this activity in The Thales Academy After School Care Program. I further agree to release The Thales Academy After School Care Program and all of its staff, members, or agents, from any and all liability for any damage, loss or theft of personal property. I also agree to waive all rights of subrogation.

In the event any injury, illness or other condition, which would require immediate medical assistance, I hereby consent to allow The Thales Academy After School Care Program and all of its staff, members or agents to take such actions as necessary to contact and provide emergency and medical assistance. I hereby consent to assume all financial responsibility for such medical assistance.

I have carefully read this wavier and release agreement and fully understand it is a release of any and all liability, claims, and other actions whatsoever. I also understand that failure to sign this wavier and release agreement will prevent my child from participating in this activity and my payment will not be refunded.
Signature:

Payment
I have read the After School Care payment policy and agree to all of its terms.
Signature:
How often are you planning for your child to attend?

Policies
I have read the After School Care policies and agree to all of its terms.
Signature
Should be Empty:

After School Care Registration (2026-2027)

Parent/Guardian Information

Emergency Contact

Medical Information

Release Information

Photo Release

Waiver

Payment

Policies