1 Child/ Part Time - Athenian Academy

After School Program
Registration Form

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 picked up by 6:00pm daily- or $10 fee will be applied for late pick up

· NO ONE other than who is on the designated pick up list may pick up child, and they must have photo ID at time of pick up.
Pick up will be in Cafeteria, East side door by portables

·Parents MUST call 727-298-2718 x506 by 2:00pm to notify us if their child will NOT be going to after care that day. If they do not call we will consider the child missing and will be calling all emergency contacts until we get confirmation child’s whereabouts.
VERY important to call if your child will not be going to after care that day.

· 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. ($15 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*

18851 Oak Center Dr

(239) 319-0522

After School Program
Registration Form

Clearwater

Ft Myers

Copyright 2021 © All rights Reserved. Design by Angel

18851 Oak Center Dr

(239) 319-0522

After School ProgramRegistration Form

Clearwater

Ft Myers

Copyright 2021 © All rights Reserved. Design by Angel

After School Program
Registration Form