Arts Enrichment Registration Form

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This form is an application to the Arts Enrichment After School Program. Our enrollment is limited and may be closed to new enrollment at any time during the year. You may fill out just 1 form for the family. Please put the information for each child in the additional children section.

Student's First Name *

Student's Last Name *

Student's Grade for the 2020/2021 School Year *

Required

Are there any other students in the family, who will be attending the Arts Enrichment Program? Please write their first and last name and the grade they are in this year.

Student's Home Address (Please include the street, city and zip code) *

Mother's Name

Mother's Phone Number

Mother's Place of Employment and work phone number?

Mother has permission to pick up your child/children from the Arts Enrichment Program? *

Yes

Father's Name

Father's Phone Number

Father's Place of Employment and work phone number?

Father has permission to pick up your child/children from the Arts Enrichment Program? *

Yes

Please List ALL of the other people who you authorize to be able to sign your child/children out of the Art's Enrichment Program below. Please include their first and last name, their relationship to the child and their phone number. *

Please list custody restrictions or special arrangements: (You must have custody papers on file with the school office/FOCUS)

Please list any food allergies that your child may have. If your child has a medical condition, please notify the Arts Enrichment Program Director before starting the program.

Please read the Parent Information Packet. By checking off the topics below, you agree that you have read about them and agree to the following terms.

The $50 weekly rate is due each week to hold your child(ren)’s spot in the Arts Enrichments Program whether your child(ren) attend(s) every day or not.on 1

A $25 late payment fee is added each week, a payment is late. More than three late payments could result in dismissal of the program.Option 2

A $10.00 late fee is charged for the first 15 minutes after 6:00 PM. Arriving after 6:15 p.m. will result in an additional fee of $1.00 per minute. Children who are repeatedly picked up late (three times or more) could be dismissed from the program.

Please be advised, your child(ren) will not be called for pick up until you hang up your phone. This is to ensure that we may have your attention to discuss money matters, behavior concerns or any other concerns.

Phones, electronic games and toys from home are not allowed in the Arts Enrichment Program. Arts Enrichment staff are not responsible for lost, broken, or stolen items.

Your child(ren) may watch G/PG movies while at the Arts Enrichment Program.

The Arts Enrichment Program reserves the right to dismiss any child from the program at any time because of behavior issues.

I have read and agree to all the information in the Arts Enrichment Program Parent Information Packet. I acknowledge and understand that my child's AEP balance must be paid in full so that my child may attend/ participate in any extended day activities (including but not limited to: Clubs, Dances, Trips and Tutoring).

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