Before Care - 3 Students - Athenian Academy

Before Care Program
Registration Form

1st Student’s Information

First Name*

Last Name*

Birthday*

Grade*

Does this student have any allergies?YesNo

If Yes, Please Specify

2nd Student’s Information

First Name*

Last Name*

Birthday*

Grade*

Does this student have any allergies?YesNo

If Yes, Please Specify

3rd Student’s Information

First Name*

Last Name*

Birthday*

Grade*

Does this student have any allergies?YesNo

If Yes, Please Specify

Parent’s Information

Mother’s First Name*

Mother’s Last Name*

Phone Number*

Email Address:*

Father’s First Name*

Father’s Last Name*

Phone Number*

Email Address:

Any special needs or notes you want us to consider?

Designated pickup/ Emergency Contacts

Enter ALL ( Including Parents) names that will be allowed to pick up student
*Any person NOT on this list will not be able to pickup student

First Name*

Last Name*

Phone Number*

First Name*

Last Name*

Phone Number*

First Name

Last Name

Phone Number

First Name

Last Name

Phone Number

First Name

Last Name

Phone Number

Terms & Conditions

·Child must be dropped off between 7:00am-8:15am daily

· Child Will have to have their temperature recorded before they will be allowed to enter
· Cancellation policy- 30 days written notice! If failure to provide proper notice then tuition will continue through that month of cancellation

· Tuition will continue through entire school year, even during times of school being closed for holidays. There will be Camps available at an additional discounted rate for after school children. ($20 extra per day + any field trip fees, on top of normal continuous tuition)

*check here to acknowledge you read and agree to our terms & conditions

Signature of Parent or Legal Guardian ( Mouse or Finger )*

Today’s Date*

2289 N Hercules Ave

(727) 298-2718

Before Care Program
Registration Form

Clearwater

Ft Myers

Copyright 2020 © All rights Reserved. Design by Angel

2289 N Hercules Ave

(727) 298-2718

Before Care ProgramRegistration Form

Clearwater

Ft Myers

Copyright 2020 © All rights Reserved. Design by Angel

Before Care Program
Registration Form