**EARLY REGISTRATION ENDS MONDAY, AUGUST 31** YSP Online Registration Form Child's Name* First Last Name of SchoolTeacher's Name First Last Child's GradeRoom NumberSelect One Before School After School Both Child's Birth Date MM slash DD slash YYYY Child's AgePlease enter a number less than or equal to 15.Parent's Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Alternate PhoneEmail* Please note by listing names and numbers on this form gives YSP authorization to contact and release your child to individuals and persons listed. Emergency Contact ListNameTelephone AcknowledgementAcknowledgement - I have read, understand and agree to the rules of contract for the YSP BEFORE & OR AFTER SCHOOL PROGRAMS.* Yes • Homework is a parent child activity, however there is homework time in our afterschool schedule. Please note homework may get started, depending upon your child’s work pace it may not be completed in the timeframe given. Parents are responsible to check all home assignments for completion and accuracy. • A pre-packaged snack is available to all children who attend the program. Please note if a child has any type of food allergy to list this information in the medical portion of this form. • Please note a payment schedule is given upon registration. All payments are to be received on time in compliance with the payment schedule. We do not accept ANY partial payments. FULL payment is to be received in order for your child to be collected and or received daily. • PLEASE NOTE IF PAYMENT IS NOT RECEIVED IN A TIMELY FASHION WE ARE NOT RESPONIBLE TO PICK UP AND OR COLLECT YOUR CHILD(REN). If at any time a payment is missed for any reason your child’s slot is not guaranteed without past balances (late fees, monthly fees) being paid in full. If your child is out for ANY REASON illness, vacation, suspension etc. FULL payment is expected in order for child(ren) to return to program. Meaning previous months that child did not attend due to absences. Without payment your child(ren) will be dropped from enrollment and the slot will be filled. All payments and deposits are non-refundable, this includes any payments made in advance. Payments will ONLY be adjusted for Winter and Spring Break ONLY. If school is closed for weather, or any other scheduled or non-scheduled day or days FULL payment is STILL due for the entire month. NO EXCEPTIONS. • ALL LATE PAYMENTS ARE SUBJECT TO A $5.00 PER DAY LATE FEE; PER CHILD. • We are NOT responsible for ANY lost or stolen items. • Please note on the emergency form you are agreeing that the info is true and correct. If persons are not listed on the emergency form, we haven’t received phone consent, and or if persons ID is not available, we are unable to release the child. • There is Absolutely no disrespect and or misbehaving from children and or parents to staff and anyone else associated with the program. If an altercation occurs on the parents and or child’s behalf both will be dismissed immediately. With NO REFUNDS; NO EXCEPTIONS. • Parents and or guardians MUST be on time in picking up children. If children are picked up ONE MINUTE after scheduled time the fee is $1.00 PER MINUTE; PER CHILD. NO EXCEPTIONSRegistration Fee $65.00* Yes, Please register my child CAPTCHATotal $0.00
