Blastoff Learning Academy

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Please complete this form to indicate your interest in the Blastoff Learning Academy offered through Rochester CUSD 3A for students currently enrolled at Rochester CUSD 3A. (1 application per child please)

Email *

Student Last Name *

Student First Name *

Student Birthdate *

YYYY

Grade Your Child is Currently Enrolled In Rochester Schools *

PreK

Required

My child is age 3 to 12. *

Yes

Required

I would like my child to be considered for... *

Part-time after school care during the school year

Full-time after school care during the school year

Part-time care during the summer 2024 (must be an current student)

Full-time care during the summer 2024 (must be a current student)

Care on school improvement and Teacher Institute Days

Care during winter break

Part-time care during spring break

Full-time care during spring break

Required

I understand that this application does not guarantee that my child has a placement in the Blastoff Learning Academy and that I will be contacted by school staff to confirm enrollment or be placed on a wait list. *

Yes, I understand.

Required

I understand that my child has to be signed in and out daily. *

Yes, I understand.

Required

I understand that I must pick my child up by 5:00 in the evening, that I will be charged $15 per child if they are picked up late, that authorities will be contacted if the child is picked up late, and that two late pick ups result in immediate dismissal from the program. *

Yes, I understand.

Required

Who is responsible for payment? *

I understand that all payments must be up-to-date for my child to attend the program. *

Yes, I understand.

Required

My child is currently enrolled in Rochester CUSD 3A. *

Yes

Name of guardian or parent completing this form.

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

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