KJ Afterschool Registration - Summerfield Charter Academy

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

KJ Afterschool Registration - Summerfield Charter Academy - 2023-24

We are accepting registrations for the 2023-24 school year! Please sign up ASAP to secure a spot for next year!

Email *

Is your child's school Summerfield Charter Academy? If yes, please continue. If not, please go back to our homepage and click on the form associated with your child's school. *

Yes, my child's school is Summerfield Charter Academy

Required

What is your child's First Name (or name he/she goes by)? *

What is your child's Last Name? *

What is Parent 1's name? *

What is Parent 1's email address? *

What is Parent 1's cell phone number? *

What is Parent 2's name (if applicable)?

What is Parent 2's email address?

What is Parent 2's cell phone number?

What email address is associated with your paypal account? List all that may apply. *

What is the child's address? (Please list all that apply.) *

Please write the name of an emergency contact we may reach if you are not able to be contacted. *

Please give the emergency contact's cell phone number. *

Please write the name of an additional emergency contact. *

Please give this person's cell phone number. *

What grade is your child in? *

Does your child have any allergies? *

Yes

If your child does have allergies, please list them here:

Does your child take any medications? *

Yes

If your child does take medications regularly, please list them here:

I agree to adhere to the payment schedule as prescribed in the payment worksheet. Failure to make payment will result in a $20 fee. Late pick-up (after 6:00 pm) will be assessed a $5 fee for the first occurrence, $10 with the 2nd occurrence, and $10 with a conference with the Director for the 3rd occurrence. Each child will be held to the school standards of behavior within our program. Discipline issues will be handled on a case-by-case basis at the Director's discretion. I acknowledge and represent that I have read, understand, and accept all terms stated in this document as they relate to KJ Afterschool, LLC. By checking the box below, I agree to adhere to all policies, agreements, waivers and procedures of KJ Afterschool, LLC. *

I Agree

Thank you for completing your registration information! Now, please go to our website: https://kjafterschool.wixsite.com/happykids Click on the "Pay Now" Button to pay the $75 registration fee PER CHILD. This payment covers the registration fee and the cost of the first short week of school. Payments may be made by credit, debit or PayPal. When we get into August, you will be given a link that will be the year's subscription to our program. Once you subscribe, you will be autodrafted each week of KJ through the '23-24 school year. *

Got it

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms