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Afterschool Application

Student’s Name:(Required)
Prices:(Required)
Parent/Guardian Name:(Required)
Parent/Guardian Name:
Student’s Address:(Required)
Child’s Date of Birth:(Required)
ELC:(Required)

Method of Payment:

All payments will be processed through LineLeader.

Tuition is billed each Monday or Monthly on the 4th.

Consent(Required)
Signature:(Required)
If parents cannot be reached in an emergency, the following people should be contacted:(Required)
Name
Phone #
Alternate Phone #
 

TRANSPORTATION AUTHORIZATION

in Gallop’s Family Center Inc. vans.
Parent Signature(Required)

RECEIPT OF CHILDCARE POLICIES

I have received and understand all the childcare policies provided to me in this registration packet. I agree to adhere to all policies and procedures outlined in this packet.
Parent Signature(Required)

PHOTO RELEASE

will mark the space below to grant or not grant permission of photos of my child to be used in the manner below.
Use still photos in promotional materials(Required)
Display still photos on facility’s website(Required)
Display in facility’s bulletin boards, show to current and prospective clients(Required)