After School 2024-2025

2024-2025 After School Registration
All registrations are received and reviewed on a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

Payment Policy: A $35 registration fee per school year for each student along with the first week payment are due at the time of registration to secure enrollment.

A two-week notice is required to withdraw from the program. All payments are non-transferable and non-refundable. NO refunds, credits, or transfers. All fees are payable as scheduled regardless of attendance.
Student Information
First Name*
Last Name*
Gender*

FemaleMale
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*
School Attending*
Entering Grade for Current School Year*
Are you registering your student for drop-in care or regular afterschool care?*
Drop-in is for students who will only attend the after school program during offered breaks and events. (ex. Thanksgiving, Christmas, Fall break, Spring Break, etc.)
Your Child's School/Afternoon Pick-Up Location*
Does Your Student Require a Child Safety Seat?*
Is this Student Returning or New to Element Adventures After School Care?*
Doctors Name*

First NameLast Name
Doctors Phone Number*
Doctors Address
Expected Start Date*

MonthDayYear
Date
Parent/Guardian Information 1
Full Name*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Home Phone*
Cell Phone
Parent's Work Place
Work Phone
Where would you like to be reached while your child is at Element Adventures?*
Address - Same As Child*

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information 2
Full Name

First NameLast Name
Relationship to Child
E-mail
example@example.com
Home Phone*
Cell Phone
Parent's Work Place
Work Phone
Where would you like to be reached while your child is at Element Adventures?*
Address - Same As Childs*

YesNo
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact - Other than Parent/Guardian
Full Name*

First NameLast Name
Relationship to Child*
Home Phone*
Cell Phone
Work Phone
Other Infomation
Does your child have any food, medication or environmental allergies?*

YesNo
If yes, please list any food, medication or environmental allergies
Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?*

YesNo
If yes please list.
Does your child have any medical conditions?*
Does your child require any medication? If yes, please list these medications.*
Do you authorize us to administer the medications listed above?*

YesNo
Please list the people authorized to pick up your child.*
I give my permission for Element Adventures to pick up my child from school and transport them to the Element Adventures facility.*

Agree
I understand that the Element Adventures After School Care Program is an active program with physically challenging activities available for student participation.*

Agree
I give permission for my child to be transported by Element Adventures staff to and from Element Adventures facility for field trips.*

Agree
I understand that climbing walls, indoor and outdoor play equipment, inflatable obstacles, slides, and basketball play entail certain risks. Those risks can include increased heart rate, blood pressure, strained or sprained muscles, fractured bones, partial or complete paralysis, heart attacks, psychological injury, death, or any possibility of other serious injuries. I elect to allow my child to participate in spite of these risks.*

Agree
I understand my child will be asked to sit quietly for a short period of time each afternoon to complete homework and/or reading. (Allowable personal electronic and/or gaming time is after homework time.)*

Agree
I understand my child may be photographed and photos may be used in media publications that would represent Element Adventures and its program in a positive manner.*

Agree
I knowingly and voluntarily assume all risks involved in my child's participation, and do hereby release Element Adventures, and its members, trustees, officers, employees, independent contractors and agents from any and all liability, damages, costs, and expenses arising out of or relating to bodily or psychological injury, loss of life or personal property that may occur as a result of participating in this program, regardless of the cause.*

Agree
I agree to give a two week written notice if I would like to withdraw my child from the program. The remaining balance must be paid in full at the time of notice.*

Agree
I understand that each week of care must be pre-paid two weeks in advance and weekly payments are due each Friday thereafter. There is a $15 late fee for accounts that fall past due.*

Agree
I understand that bad language and behavior that is disruptive, disrespectful, and/or aggressive will not be tolerated and further agree that dismissal of the student is at the discretion of the Program Director.*

Agree
Element Adventures has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*

Agree
My child and/or I have read, understand and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation in the said program.*

Agree
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.
Signature*

Clear

My Products

Element Adventures After School Care Registration FeeOne time registration fee.

$35.00 Quantity

Part-timePart-time weekly rate

$60.00 Quantity

Full-timeFull-time weekly rate

$75.00 Quantity

Total

$0.00

Credit Card

Should be Empty:

2024-2025 After School Registration

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Emergency Contact - Other than Parent/Guardian

Other Infomation

Credit Card