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ASP Registration Form 2024-2025

The After School Program Registration Form for the 2024-2025 school year requires a non-refundable registration fee of $100 per child and detailed information about the child, including medical conditions and school details. Parents must select a minimum of three days for attendance and provide payment through monthly invoices. The form also includes sections for emergency contacts, pick-up permissions, and parental agreements regarding program policies.

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Saeed Mohebbi
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34 views

ASP Registration Form 2024-2025

The After School Program Registration Form for the 2024-2025 school year requires a non-refundable registration fee of $100 per child and detailed information about the child, including medical conditions and school details. Parents must select a minimum of three days for attendance and provide payment through monthly invoices. The form also includes sections for emergency contacts, pick-up permissions, and parental agreements regarding program policies.

Uploaded by

Saeed Mohebbi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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After School Program Registration Form

2024-2025 School Year


Please read the following registration package carefully and fill out each information field
completely. To secure your spot, a non-refundable registration fee of $100/CHILD must be paid
to LVX, by e-transfer, credit card, or cash and this package must be returned. Please print
clearly.

1. Name of Child(ren):
• Child #1
i. Name: _________________________________
ii. Date of Birth (DD/MM/YYYY): ______________
iii. Please let us know if your child has any medical or mental conditions,
previous injuries, or has had surgery:
____________________________________________________________

• Child #2
i. Name: _________________________________
ii. Date of Birth (DD/MM/YYYY): ______________
iii. Please let us know if your child has any medical or mental conditions,
previous injuries, or has had surgery:
___________________________________________________________

• Child #3
i. Name: _________________________________
ii. Date of Birth (DD/MM/YYYY): ______________
iii. Please let us know if your child has any medical or mental conditions,
previous injuries, or has had surgery:
____________________________________________________________

• Child #4
i. Name: _________________________________
ii. Date of Birth (DD/MM/YYYY): ______________
iii. Please let us know if your child has any medical or mental conditions,
previous injuries, or has had surgery:
____________________________________________________________

**Do you grant LVX Incorporated permission to use photographs of your child(ren) for any legal
use, including but not limited to publicity, advertising, illustration, and social media (please
circle one)
YES NO
2. School Information:
Name: ___________________ Phone: ________________

Email: ____________________ Bus #: _____

3. Please circle days needed. Must be the same day of every week, and a minimum of 3
days:

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

Start Date: _______________________

4. Will your child be registered in any other LVX Programs:


• Recreational Class - day/time: ________________________________________
• Pre-Competitive (by invite) - day/time: _________________________________
• Competitive - day/time (by invite): ____________________________________

5. Fees for 2024-2025:


• $77 +tax/week
• $19 +tax/day (min. 3 days)
• $12 +tax/day if you are registered in a class starting at 4:30pm or 5pm
• $0/day if training 4+ hours/week or have a class at 4pm
• There will be an additional late fee for pick up past 5:30pm
i. 5:31pm-5:45pm = $25
ii. 5:46pm-6:00pm = $50

6. Payment Details:
• Payment for our After School Program happens through monthly invoices sent
out on the 1st of every month, and must be paid within 2 weeks. Payment can be
made by credit card, e-transfer ([email protected]) or cash. You can
view and pay your invoices by logging into your account through our main
website: junglegym.uplifterinc.com.

7. Family Information:
• Parent #1 Name: _________________________________
Cell Phone: ______________________________
Work Phone: _____________________________
Home Phone: ____________________________
Email: __________________________________
• Parent #2 Name: __________________________________
Cell Phone: _______________________________
Work Phone: ______________________________
Home Phone: ______________________________
Email: ____________________________________
• Home Address: _______________________________
City: ___________________________________
Postal Code: _____________________________

8. Others allowed to pick-up:


• Names: ___________________________________________________________
___________________________________________________________

9. People NOT allowed to pick-up:


• Names: ___________________________________________________________

10. Password:
• This password will be required upon pick-up by any adult, including parents.
• Password: ____________________________________

11. ABSENT DAYS:


• Parents MUST notify LVX on the days that their child will not be getting off the
bus, by email or phone.

I, ___________________ (parent/guardian printed name), agree to the following:

ü I have completed and understand all information fields in this package.


ü I have paid the non-refundable $100/child registration fee.
ü I have submitted photos (by email) of myself, my child(ren) and those allowed to pick-
up.
ü I am responsible for letting staff of LVX know when my child(ren) will not be getting off
the bus at the facility, by email or phone.
ü I understand that there is no refund or credit given if a child is sick.
ü I understand that if the buses are cancelled, we will still be running the After School
Program.
ü I understand the program does not run when there is no school: holidays, PA Days etc.
ü I must sign out my child upon pick-up from the gym.
ü I have thoroughly read and understand the After School Program Policy.
o I am familiar with the cancellation and schedule change section.
o I am familiar with the parent/guardian expectations section.
o I am familiar with the dismissal from program section.

Parent/Guardian Signature: _____________________________ Date: ___________________

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