Registration Permission Form - Afterschool Classé

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Spark Clubs Permission Form

The school year - 2017-2018

Students will be selected on the first come basis and must receive confirmation directly from your Afterschool Club.

Student Name(*)

Please let us know the student's name.

Please enter the grade level(*)

Please enter the grade level

Age(*)

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Birthdate

/ / Invalid Input

Teacher

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Address(*)

Please enter address

City(*)

Please enter the city

State

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Zip Code(*)

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Gender(*)

MaleFemale Invalid Input

Your Email(*)

Please let us know your email address.

Parent 1 or Legal Guardian

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Parent 2 or Legal Guardian

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Parent1 Day Phone

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Parent1 Cell Phone

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Parent1 Email

Invalid Input

Parent2 Day Phone

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Parent2 Cell Phone

Invalid Input

Parent2 Email

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Family's Member Name

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Family Member's Day Phone

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Family Member's Cell Phone

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Family's Cell Number

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Family Member's Email Address

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Relationship to student:

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Registration choices will be forwarded to the following Clubs

Invalid Input

Description Club 1

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Description Club 2

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Description Club 3

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Discipline Permission:
I understand that regular school rules also applies to the after school clubs. I also understand that if my child does not follow the school rules, then he/she can be removed from that after school club for the remainder of the school year.(*)

YesNo Invalid Input

Student Picture Release Permission:

Springdale Park’s After School Clubs has my permission to use pictures of my child during afterschool activities for local media sources as well as posting on the website for the purpose of sharing program information with the community.(*)

YesNo Invalid Input

Dismissal Permission:
I understand that if I do not pick up my child at the end of the club meeting sessions, I will release/pick-up them, space permitting to After School Classe’ (ASC), the SPARKS’s after school program. The ASC drop in fee is $25.00. This fee is due at time of pick up.(*)

YesNo Invalid Input

My child will be picked up by:

Invalid Input

Relationship to student

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My child will be released only to the person(s) authorized as stated. I have read and understood the above policies and statements.

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Enter today's date(*)

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Are you human?

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Spark Clubs Permission Form

The school year - 2017-2018

Main Office

Springdale Elementary

Mary Lin Elementary

Spark Clubs Permission Form

The school year - 2017-2018

Main Office

Springdale Elementary

Mary Lin Elementary

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