R.E.A.C.H. PROGRAM APPLICATION 2023-2024

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Please complete this registration form for EACH CHILD you wish to enroll in the Before & Aftercare Program for the 2023-2024 School Year.
Space is limited. Enrollment is based on a first come first served basis. Parents must re-enroll each year.

Childcare fees are due the 1st of each month. Failure to pay each month will result in suspension of services. You may not register until all previous account balances are paid in full.

Email *

STUDENT LAST NAME *

STUDENT FIRST NAME *

STUDENT GRADE LEVEL IN 2023-2024 *

PK 3

PK 4

1ST

2ND

3RD

4TH

5TH

STUDENT DOB *

YYYY

PARENT (1) LAST NAME, FIRST NAME *

PARENT (1) PHONE NUMBERS (LIST ALL) *

PARENT (1) EMAIL ADDRESS *

PARENT (2) LAST NAME, FIRST NAME *

PARENT (2) PHONE NUMBER (LIST ALL) *

PARENT (2) EMAIL ADDRESS *

CHOOSE WHICH PROGRAM OFFERING YOU WISH TO ENROLL YOUR CHILD IN *

BEFORE CARE

AFTER CARE

BEFORE AND AFTER CARE

AFTER CARE - EARLY DISMISSAL DAYS ONLY

Required

LIST ALL AUTHORIZED PERSON(s) FOR PICK UP LAST NAME, FIRST NAME AND PHONE NUMBER *

LIST ANY STUDENT FOOD ALLERGIES OR MEDICAL NEEDS

Emergency Care. In the event of an emergency I/we authorize my/our child(ren) to be treated by STAFF using CPR/First Aid and/or to be sent to Hospital for further treatment if necessary. *

Yes

LIST HOSPITAL PREFERENCE *

I/We have read, understand and agree to adhere to all of the policies, procedures and expectations outlined in the Museum Academy Before/After Care Family Handbook. Please enter your initials below. *

I/We understand and agree that my/our child may be removed from the program at any time due to behavior outlined in the Family Handbook. Please enter your initials below. *

I/We understand and agree to pay the for the child care services the week before they are provided or at the start of the month. Please initial below. *

I/we understand nonpayment could result in suspension or termination from the program. Please enter your initials below. *

I/we agree will pay all fees owed on a MONTHLY basis including a $10 late charge that will be added if you arrive after 5:30 PM to pick up your child(ren). Please enter your initials below. *

I/we understand that program fees are owed for M-F regardless of child's attendance in the program. To disenroll your child you must send a formal email in order to not be charged for the following month. Please enter initials below. *

Signature. By entering your FULL NAME below, you are digitally signing that you have read and reviewed the policies and procedure of the Museum Academy REACH program and will follow the procedures and policies as outlined in the 2023-2024 REACH Handbook. *

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

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