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
Monday (2pm-3pm) Fall into Wellness 5-Week Workshop Series for Kids (Begins in November - $150)Monday (2:15pm-3:15pm) - Basketball (grades 3-6)Monday (2:15pm-3:15pm) - Basketball - Drills and Skills (grades 7-12)Tuesday (2:15pm-3:15pm)- Flag Football (grades 5-12)Tuesday (2pm-3pm) - Arts & Crafts (grades PreK-4)Tuesday (2pm-3pm) - After Care optionWednesday (2pm-3pm) - Soccer (grades PreK-4)Wednesday (2pm-3pm)- After Care optionThursday (2pm -3pm) - Basketball (grades PreK-4)Thursday (2pm-3pm) After Care option
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:

I agreeI disagree
Electronic Signature
Date

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Date
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