After School Program Enrollment Form Drop In Registration

After School Program Drop-In Registration

2025-2026
If your child will attend the After School Program (ASP) on a regular basis throughout the year, please register for contract care through your Veracross Family Portal. Contract rates offer substantial savings compared to the hourly drop-in rate and include coverage on Early Dismissal Days.

If you are registering for Drop-In attendance only, please use this form. Drop-in students will be charged at the hourly rate of $11.50, including on Early Dismissal Days.

Please complete and submit one form per student being registered for Drop-In care in the After School Program.
Parent's Name*

First NameLast Name
Parent's Phone Number*

Area CodePhone Number
Parent's Email*
Student's Name*

First NameLast Name
Grade in fall (2025-2026)*

JrKKindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8
Effective date for enrollment in After School Program*

MonthDayYear
Please indicate the month and day that this agreement is to take effect. For example, if you will be using the After School Program from the first day of school, enter 08-14-2025.
Please confirm your registration for the Drop-In After School Program:*

Drop-in rate of $11.50 per hour
Indicate the day(s) that you anticipate utilizing the After School Program:*

MondayTuesdayWednesdayThursdayFridayDays to be Confirmed
If you have any specific details or schedules you'd like to include for Drop-In Registration, please provide them here:
Please indicate your child's default dismissal plan:
My child will remain in the After School Program until being picked up on:

MondayTuesdayWednesdayThursdayFriday
My child will take the Cannon School Activity Bus (available only for Middle School Students) on:

MondayTuesdayWednesdayThursdayFriday
Please note any known allergies:
Please specify each person, including the name of parents, who has permission to pick up your child from the After School Program.
Authorized Person 1:

First NameLast Name
Phone Number 1:

Area CodePhone Number
Authorized Person 2:

First NameLast Name
Phone Number 2:

Area CodePhone Number
Authorized Person 3:

First NameLast Name
Phone Number 3:

Area CodePhone Number
Authorized Person 4:

First NameLast Name
Phone Number 4:

Area CodePhone Number
Statement of Fees & Policies
- Drop-in charges and late fees will be billed monthly. Payments are due upon receipt. A late fee will be assessed at a rate of 1.5% per month on all accounts past due. Delinquent accounts may result in dismissal of student from the After School Program.
- The After School Program concludes promptly at 6:00 p.m.. A Late Pick-Up Fee of $1 per minute will be charged for pick-ups after this time (applies to both contract and drop-in students).
- JrK-8th grade students remaining on campus after 3:00 p.m. are required to attend our After School Program unless they are participating in a supervised program such as sports, tutoring, clubs, or a Beyond the Bell enrichment offering.
- Students may participate on a drop-in basis with prior notification from parents. If no registration has been previously submitted, you will be sent an email with the link to this form to complete and submit.
- Only persons authorized by the parent or guardian may pick up your child from the After School program. Please notify the Enrichment Programs office in writing if anyone other than a parent/guardian will pick up your child.
- All students attending the After School Program are required to follow all school and program rules. Behavioral problems will result in parent notification and possible suspension from the program.
- Students with a fever or contagious illness may not participate in the program.
- This program is available for all currently enrolled Cannon students, grades JrK - 8.
I have read and understand the Statement of Fees and Statement of Policy contained here.*

Agree
I give Cannon School permission to bill my student's account for the After School Program services indicated on this Registration Form, according to the Statement of Fees.*

Agree
Should be Empty:

After School Program Drop-In Registration

Statement of Fees & Policies