Club M.A.X. 2024 Registration                                                                                                                           

Where: Shelter Rock Elementary School
Option 1 ($2700) 7:30am - 6:00pm July 8 - Aug 2 
Option 2 ($2300) 9:00am - 4:00pm July 8 - Aug 2 
Option 3 ($1300) 7:30am - 6:00pm Aug 5 - Aug 9

 *****New this year!***** (weekly options)
Option A-1($775) 7:30am - 6:00pm July 8 - July 12 
Option A-2($675) 9:00am - 4:00pm July 8 - July 12
Option B-1($775) 7:30am - 6:00pm July 15 - July 19
Option B-2($675) 9:00am - 4:00pm July 15 - July 19
Option C-1($775) 7:30am - 6:00pm July 22 - July 26
Option C-2 ($675) 9:00am - 4:00pm July 22 - July 26
Option D-1($775) 7:30am - 6:00pm July 29 - Aug 2
Option D-2 ($675) 9:00am - 4:00pm July 29 - Aug 2

**REGISTER AND MAKE PAYMENT BY MAY 3rd AND GET $100 OFF** (Only for Options 1 or 2)

Payment Options
1.) Please make check payable to M.A.X. and deliver to the main office at Munsey Park or mail it to M.A.X., c/o Munsey Park School, 1 Hunt Lane, Manhasset, NY 11030

2.) Direct Bank Transfer - we will send you an invoice via email with directions. A $10 fee applies.*

3.) Credit Card - we will send you an invoice via email with directions. A 3% fee applies.*

* M.A.X. does not receive any part of the fees.  The fees are being passed through as a processing fee from the bank and credit card company.

Please pack lunch for your child(ren) along with a reusable water bottle.  M.A.X. will provide snacks. We are a NUT FREE program!!!   Children should wear sneakers, bring a towel, sunblock and a bathing suit.  **LABEL** all items (clothing, lunch boxes etc)

If you have one or more children attending DIFFERENT options, then please complete one form per child.  If you have one or more children attending the SAME options, then only one form is necessary.


                                *********************IMPORTANT*************************


If your response to question #3 and #4 on the form below is "YES", you must complete OCFS Forms 6029 and 7006. If your response to question #5 is "YES", you must complete OCFS Form 7002. One form per medication.

The above forms must be completed for the summer program.  If you were in the MAX program during the school year, we can use the medical forms that we have on file as long as there are no changes. These forms are required to be on file by OCFS (Office of Children and Family Services)                        
Forms are on our website www.manhassetafterschoolxperience.org
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Email *
1.) Child #1       Last Name, First Name *
Child #1 Grade for school NEXT year (2024-2025) *
Child #2        Last Name, First Name  (Please leave blank if not applicable)
Child #2 Grade for school NEXT year 2024-2025 (Please leave blank if not applicable)
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Child #3        Last Name, First Name, (Please leave blank if not applicable)
Child #3 Grade for school NEXT year 2024-2025 (Please leave blank if not applicable)
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2.) What school does your child(ren) attend? *
If you selected "Other", please list the name of the school
3.) Does your child have allergies?   (If yes, must complete OCFS  Forms 6029 & 7006 - see above) *
4.) Does your child have asthma?  If yes, must complete OCFS Forms 6029 & 7006- see above)       *
5.) Does your child require medication?  (For example, Benadryll, EpiPen)  If yes, must complete OCFS Form 7002.  One form per medication.  See above *
6.)If you answered "Yes" to question #3, #4 and/or #5, please list the name(s) of the child that has allergies, asthma and/or requires medication. If you answered "No" to all three questions, please write N/A. *
7.) Please select your Option below. If you have one or more children attending DIFFERENT options, then please complete one google form per child.
Option 1  July 8-Aug 2   (7:30am - 6:00pm)  Leave blank if not attending on this option   
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Option 2  July 8-Aug 2   (9:00am - 4:00pm)  Leave Blank if not attending on this option    
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Option 3  Aug 5-Aug 9 (7:30am - 6:00pm)  Leave Blank if not attending on this option
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Option A - First Week of July (July 8-12)  Leave blank if not attending this option
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Option B - Second Week of July (July 15 - July 19)
Please leave blank if not attending
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Option C - Third Week of July (July 22 - July 26)   Please leave blank if not attending
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Option D - Fourth Week of July (July 29-August 2)  Please leave blank if not attending 
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Option D - Fourth Week of July (July 29-August 2) Please leave blank if not attending 
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Emergency Contact #1  (Name and Phone number)  *
Emergency Contact #2 (Name and Phone Number) *
Any additional information that we should know about your child.
Payment Option *
I give permission for the M.A.X. staff to render First Aid to my child(ren) as needed or to contact my child's doctor if I am not available. *
I give the M.A.X. Staff permission to seek emergency medical treatment in the event that I cannot be contacted immediately.  The M.A.X. Director or Site Supervisor will call 911 and escort my child by ambulance to the said hospital. *
I give permission to M.A.X. to use art work and photographs of my child for publicity purposes and for fundraising for the M.A.X. program. *
By entering my name below, I acknowledge that all of the information that I provided is correct.  I also understand that I must inform M.A.X. of any special needs or problems my child may have. *
A copy of your responses will be emailed to the address you provided.
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