Halifax Youth and Recreation After School Sports Registration

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Please complete and submit this form in order to register your child for After-School Sports. Please send in payment to the school by form of check, made out to the Town of Halifax, prior to the session starting.

1 child - $40/session. Prepay for all sessions (8th session free) - $280
2 children - $65/session. Prepay for all session (8th session free) - $455
3 children or more - $85/session. Prepay for all sessions (8th session free) - $595

Student Name *

Teacher *

Mr. Bayramshian

Mr. Kaetzer

Miss Woodman

Miss Morse

Ms. Belcher

Mr. Dray

Mrs. Troskey

Mrs. Mullin

Ms. Lasek

Mrs. Belsky

Ms. Savage

Ms. Parker

Ms. Sarney

Mr. Howe

Mrs. Whitney

Mrs. Shaw

Required

Grade *

Sessions *

All

Session 1: September 10 - October 3

Session 2: October 8 - November 1

Session 3: November 6 - December 5

Session 4: December 10 - January 17

Session 5: January 21 - February 13

Session 6: February 25 - March 20

Session 7: March 24 - April 16

Session 8: April 28 - May 21

Session 9: TBD

Required

Health Conditions (medications, allergies, etc.) *

Cell Phone *

Alternate Phone *

Email *

Emergency Contact Name *

Emergency Contact Phone Number *

Does your child attend the YMCA program on the day that his/her group meets? *

Yes

Parent Carpool: Please list the names of all individuals that you authorize to pick up your child. Any individuals not listed will need permission with a note. (Proper identification will be required.) *

Please re-type the following statement and write your name at the end: I give (student's name) permission to be dismissed to the gym lobby on (list days). *

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