• After School Registration Form

    After School Registration Form

    School Year 2025-2026
  • Program Overview, Pricing, and Dates

    August 12th - May 22nd
  • Our after-school care is for children in K-6th grade. Children who attend our program receive a healthy snack on arrival and have access to our intentionally designed classrooms, 2800 sq. ft. gym, and our brand new playground. Children participate in a variety of stimulating indoor and outdoor activities.

    You can learn more about our program by visiting our website here: https://clubinfiniti.org/

    We plan to serve the following schools, but please be advised that this could change based on enrollment demands from each school: Apple Glen, Ardis Ann, Bright Field, Centerton-Gamble, Central Park, Creekside, Elm Tree, Evening Star, Mary Mae Jones, RE Baker, Ruth Barker, Sugar Creek, Thomas Jefferson, Old High, Osage Creek, Willowbrook and Vaughn.

    • Program dates are Tuesday August 12th to Friday May 22nd.
    • Program Hours are 2:45pm to 6:00pm
    • Tuition Rates: (Take $5 off if on auto-pay)
      • Tuition 5 days : $110/week 1st child; $100/week 2nd child
      • Tuition 4 days: $100/week 1st child; $90/week 2nd child
      • Activities Fee: $70 due each semester (August & January)
      • Annual Membership fee: $50/child; $90/family
    • All fees are due upon enrollment to hold your child's spot in the program; Fees are non-refundable if you cancel your child's enrollment
    • Late Pick Up Fee: There is a $10 fee per min. per child starting at 6:01pm
    • No call/No show Fee: $5 if parents do not notify us before 1pm that their child will not need pick up that day
    • We follow the Bentonville Public School Calendar for school closure dates and inclement weather days
    • Tuition will not be prorated for school closure dates; the only week that will not be charged is the second week of Winter Break
    • Tuition is billed on a weekly cycle and always paid in advance of child care. Weekly billing is posted every Friday and due each Monday of the week of child care services and is considered late if not paid by the end of the business day (6pm)
      • Late payments will incur a $10 late payment fee
        Payments can be made online, in person, over the phone, or can be automatically drafted using an auto-draft form
    • In the event of student absence, tuition will be charged as usual in order to retain a spot in our program
    • We require advance notice if there is a change to your child's schedule; Schedule changes will incur a $25 schedule change fee
    • Please call us at 479-418-3116 if you have any questions or email info@clubinfiniti.org
    • NOTE: We can accept DHS/Tribal vouchers. Voucher approval must be finalized before your child's first day.
  • Clear
  • Child's Personal Data

  • Attendance and Transportation

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  • General Behavioral Expectations

  • By initialing below, I acknowledge that I understand the Club iNFiNiTi After-School and School Break Enrichment Programs offer group-level care that requires the cooperation of children in groups to be safe to themselves and others. Our programs include transportation on a van. School Break Enrichment Programs include field trips that are a required part of the programming, and as such, children are required to attend trips unless special permission has been granted by the Directors. By initialing, I further acknowledge that my child is capable of making safe choices and following program rules to ensure the safety of all children when on and off site.

    I acknowledge that my child will be able to follow the General Behavioral Expectations listed below:

    • To be kind and respectful to others, oneself, and Club iNFiNiTi property.
    • To be safe while being transported on a bus or van and to not distract the driver with disruptive behavior.
    • No hitting, biting, punching, throwing, pushing, pinching, hair pulling, or otherwise hurting themselves or others.
    • No name calling, teasing, or belittling of other children or other families.
    • No intentionally breaking anything, hitting, or punching walls.
    • No running, wrestling, or climbing inside unless in designated areas.
    • Children may not pick up other children.
    • No leaving the center or playground without a teacher or parent. Children will not be allowed to be left alone outside or inside the center without adult supervision, even when the parent is here.
    • All food and drink will remain in designated areas of the center and classrooms. For safety reasons, no gum-chewing is allowed by the children.

    If a child cannot meet these expectations, a parent conference will be scheduled to address the issue and come up with a behavioral plan. If the behavioral issue is not resolved within a timely manner or if the nature of the behavioral problem is so severe that the child's or other children's safety is at risk, the child will not be allowed to continue attending Club iNFiNiTi. All students are subject to a 2 week trial period when first attending Club iNFiNiTi. If we find that our program is not a good fit for your child, their enrollment will be terminated and enrollment fees will be refunded.

  • Parent or Legal Guardian Information

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  • Emergency Contact Info

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  • Adults Authorized to Pick Up Child

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  • Medical Information

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  • For the following sections, if you do not have anything to report, please write "none." These sections are required to complete enrollment.

  • Authorizations

  • I hereby give written permission for the use of sunscreen for this child in accordance with Minimum Licensing Requirements: DCCECE/Child Care Licensing Unit.

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  • I hereby give my written consent and permission for the taking of photographs and/or video of my child at the Child Care Facility or any event/location where they are participating and waive and/or assign any and all rights (including copyright) in such media to Club Infiniti, LLC. Club Infiniti, LLC, as the sole owners of such media, shall have the exclusive right to control and determine the use, display, performance, reproduction and dissemination of any such photographs and/or videos.

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  • I hereby give written permission for the Child Care Facility to pick up my child from school and be transported to the Child Care Facility on a routine basis for the purposes of attending the program.

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  • Clear
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  • Emergency Treatment Authorization

  • I, the parent/guardian of this child, do hereby give my consent to the Director of the Child Care Facility, or his/her duly appointed representative, for this child to receive medical or surgical aid as may be deemed necessary and expedient by a duly licensed or recognized physician or surgeon in case of emergency when the parents cannot be reached. Consent is also given for the Director or his/her duly appointed representative to transport said child for emergency medical treatment, if the parents cannot be reached.

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  • Acknowledgments

  • Release/Indemnification: As the parent or legal guardian of this child, I give my consent for my child to participate in the programs, events, and activities at Club Infiniti, LLC. I understand that it is Club Infiniti, LLC's expressed intent to provide for the safety and protection of my child.

    In consideration for allowing the above named minor to participate in activities at Club Infiniti, LLC and on field trips, I waive any and all rights or causes of action against Club Infiniti, LLC or its staff members for any injuries suffered by my child and other damages suffered by the child or myself while under the supervision or control of Club Infiniti, LLC and its employees. I agree to indemnify Club Infiniti, LLC for any such Claims brought by me or a third party from any costs associated with defending or litigating such claims, including but not limited to attorney fees, costs and legal expenses.  

    Assumption of Risk: I am aware of the risk of severe injury when participating in any sports or physical gym & field trip activities. I hereby voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including death that may result from participation in program or event activities.

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  • This is a statement of verification that I have been informed that child care licensing/child maltreatment investigators and/or law enforcement may possibly interview my child for the purpose of determining licensing compliance or for investigative purposes. This is in accordance with Minimum Licensing Requirements: DCCECE/Child Care Licensing Unit.

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  • This is a statement of verification that I have been informed of the behavior guidance policy practiced by the Child Care Facility and have received a copy of this policy in writing. Online version can be found here: https://clubinfiniti.org/parent-resources

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  • I, the parent/guardian of this child, understand that I may ask for a conference with Child Care Facility staff as needed.

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  • I, the parent/guardian of this child, am aware that my child may be photographed/videotaped as part of a facility video surveillance system. This information will only be used for internal reviewing purposes or for purposes as mandated and required by law.

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  • I, the parent/guardian of this child, am aware that state licensing compliance forms are available for review upon request.

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  • I, the parent/guardian of this child, am aware that Club Infiniti does not administer medication except under very specific circumstances. Please do not bring medication in your child’s bag or hand it to the teacher to administer. If approved by the facility, some medications may be administered by the Director on duty only with specific written permission AND doctor’s documentation. A Medication Form from our facility must be filled out and attached to the doctor’s documentation, and prior Director’s approval attained. Please do not send any kind of medications, vitamins, cough drops, etc. with your child or in their water bottle to school. This is a safety concern for other children.

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  • I agree to give a minimum of 2-weeks written notification of any time that my child will not be attending or to drop enrollment. I understand that I will be charged for any days missed without this notification up until and including the 2 weeks following drop notification.

    I have read and understand the fee schedule, including policies concerning COVID-19, major holidays, school closures, inclement weather, late pick-ups, late fees, and no call/no show fees. I agree to pay for all services, including any assessed late fees, provided by Club Infiniti, LLC.

    I agree to notify the Child Care Facility no later than 1pm of the given day if my child does not require pick up from school. Please note that notifying the school is not sufficient. Parents must notify Club Infiniti directly by contacting us at 479-418-3116 or at info@clubinfiniti.org. A no call/no show fee of $5 will result if we do not receive advance notice of your child's absence. This fee will apply even if we speak with you after 1pm on the given day to determine the location of your child. So that our drivers are able to maintain their route schedule, your child must be present for pick up at the designated location and time after school or they risk not being picked up for that day. A charge will be assessed if our drivers are required to return to the school for pick up if your student misses the van/bus. 

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  • Health and Child Development Information

  • Other Information

  • Attestation

  • By signing and hitting submit, you agree that you are the parent or legal guardian of the above named child, are over the age of 18, and the information provided is true and correct to the best of your knowledge.

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  • Should be Empty: