RLMA - Afterschool 2024-2025

1
Student Name* This field is required.
First Name
Last Name
2
Choose your school* This field is required.If your child’s school is not listed or your child is 12 years old+, call 561-735-0306 to request additional details
Banyan Creek Elementary
Citrus Cove Elementary
Coral Reef Elementary
Crystal Lakes Elementary
Franklin Academy Elementary
Freedom Shores Elementary
Hidden Oaks Elementary
Imagine Chancellor Elementary
Lake Worth Christian Elementary
Manatee Elementary
Home Schooled/FL Virtual School K-5th Grade
Drop off
3
Grade* This field is required.
4
Parent/Guardian Name* This field is required.
First Name
Last Name
5
Email* This field is required.
example@example.com
6
Phone Number* This field is required.
7
Does your child have any allergies, medications, medical conditions, or accommodations we should know about?* This field is required.*If none, please write none
Include allergies, medications and important wellness information
8
Authorized Pick Up ListPlease include the name of all persons authorized to pick up your child. Please inform authorized parties that they will be required to show ID.
9
After-care Registration* This field is required.
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$20
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ORDER SUMMARY
Total costUSD
After-care Registration
✓ School T-shirt
✓ Uniform
✓ Student registration
✓ Family onboarding
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Back
Total cost
Payment Methods
Credit Card
First Name
Last Name
Cash App
After submitting the form, you will be redirected to the Cash App Pay to complete the payment process.
Google Pay
After submitting the form, you will be redirected to the Google Pay to complete the payment process.
Apple Pay
After submitting the form, you will be redirected to the Apple Pay to complete the payment.
ACH Bank Transfer
Account Holder Name
10
Terms and Conditions* This field is required.
11
By signing this form I understand and agree to all terms and conditions as outlined on this registration form and as stated at raiseleaders.org/terms
12
Date* This field is required.
Date
Month
Day
Year
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