afterschool_enrichment

Afternoon Enrichment Registration Form

(Between 2pm and 3:15pm)

Our enrichment programs run in five-week sessions, each designed to give kids a focused burst of fun, learning and creativity. Every session is just $100, making it easy for families to mix and match the activities their children love most.

Parent/Guardian Full Name

Phone Number

Format: (000) 000-0000.

Email Address

example@example.com

Child's Full Name

Child's Date of Birth

Child's Grade

Select your Enrichment Program(s)

Adults authorized to pick up your child (include their phone number and relationship to child)

Emergency Contact Full Name

Emergency Contact (Phone)

Format: (000) 000-0000.

Allergies/Medical Concerns

I understand that participation in physical activities (sports, gym, etc may involve risk of injury. I release GPA: A Homeschooling Enrichment Center ("GPA"), the Homeschooling Enrichment Center of Long Island, St. Ignatius and its directors, staff, tutors, and volunteers from liability for any injuries sustained while participating in enrichment programs. I also certify that my child is physically able to participate in such programs:

Electronic Signature

Date