Garrett Elementary Before and After School Online Registration 2022-2023

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Completing this form is letting us know at Garrett Elementary that you ARE going to be using our before or after school services. A TWO WEEK notice is required to withdraw from the program. You are required to pay for all services signed up for. Thank you for helping us stay organized and making sure we have enough staff to safely take care of your child. Gator Island Staff

Email *

Student ID Number (not applicable to kindergarten) *

Grade Level For 2022-2023 School Year *

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Students Name: Last Name, First Name *

Child's Date of Birth *

mm/dd/yyyy

What kind of care does your student need? (Prices are subject to change) *

Before School from 6:30-7:20 $35 per month

After School from 2:35-6:00 $207 per month

Before and After School $230 per month

ABSS Staff Care

PRIMARY Parent/Guardian names, phone numbers, address, and e-mails *

Format: First & Last Name, Phone #s (specify cell, day, and home), Address, Email (If ABSS employee, please provide both ABSS email and an email address other than your ABSS address.)

Parent/Guardian 1 *

Work/Phone extension *

Cell # *

Address *

Email *

Parent/Guardian 2

Work/Phone extension

Cell #

Address

Do you have a custody agreement by court order? *

Yes

Yes, please explain

Are you employed by Alamance_Burlington School System? *

Yes

If you are an ABSS employee, at what location?

Emergency Contact and Pick Up authorization

The following people may pick up the child from the program and/or be reached during an emergency. In the event of inclement weather or an emergency situation. Please make sure you have made arrangements with these individuals to pick up your child/children from the program and they are accepting of this responsibility.**Please note a valid ID will be required to pick up students from daycare.

1st Pickup Name *

Relationship *

Phone# *

2nd Pick Up Name *

Relationship *

Phone # *

3rd Pick Up Name *

Relationship *

Phone# *

Is there any person prohibited from picking up the child by a court order? *

Yes

If yes, attach a copy of the court order and an explanation

Prohibited Persons Name

Relationship to Child

Important Student Information

Please list allergies and needed medications

Please list any allergies *

Please list any required medications *

Emergency Permission *

I give permission to Garrett Elementary School Daycare staff to authorize emergency treatment and transportation of my child to Alamance Regional Medical Center Hospital.

I DO NOT give permission to Garrett Elementary School Daycare staff to authorize emergency treatment and transporation of my child to Alamance Regional Medical Center HospitalOption 2

Field Trip (If Applicable) *

I give permission for my child to attend any off school field trips on teacher workdays. Transportation will be provided by ABSS buses. I give my permission for my child to be transported on buses for daycare field trips.

I DO NOT give permission for my child to attend any off school field trips on teacher workdays.

Movie Permission (If Applicable)

I give permission for my child to watch PG movies.

I do not give permission for my child to watch PG movies.

Clear selection

Participation and Payment Agreement *

My child and I have read, discussed, and agree to abide by the rules, regulations, and payment schedule for attending Garrett Elementary School Before and After School Program.

Questions and comments

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