After School Registration Form, Semester 1, Fall-Winter 2019 After School Registration Form, Semester 1, Fall-Winter 2019 There is a one-time annual Registration fee of $25.00. Student's Full Name:* First Last Student's Age as of 9/16/2019*344.556789101112Student's Classroom:*Is the student currently enrolled in Extended Day?*YesNoWhich location does the student participate in Extended Day?*10 Regent50 RegentIf the student is not already enrolled in Extended Day, will you need to enroll the student and/or the student's sibling(s) in Extended Day from 3:00PM - 4:15PM for the Fall/Winter 2019 semester?*Cost is $10.00 per classYesNoWho do you need to enroll in Extended Day from 3:00PM-4:15PM for the Fall/Winter semester?*StudentSibling(s)Student and sibling(s)Please list the name(s) of the student(s) you need to enroll in Extended Day for the Fall/Winter 2019 semester.* Does the student have any allergies?*YesNoPlease list the student's allergies and medications prescribed by the physician (if applicable).*Does the student's sibling have any allergies?*YesNoPlease list the student's sibling's name(s), allergies, and medications prescribed by the physician (if applicable).*Parent Phone Contact:*Parent 1 Email Address:* Enter Email Confirm Email Parent 2 Email Address:* Please list ALL authorized release persons (Please included first and last name, contact number, and relationship to student. *Only persons listed in this section will be allowed to pick up the student from his/her After School class.* To register, please select program(s) of interest belowPrograms listed in the following section will be scheduled for payment on October 1 through FACTS. All payments are non-refundable.Code ClubThere are no options available for this field.Hindi Language ClassMondays, Time: 3:15-4:15, Age Level: KGBalletThere are no options available for this field.BalletThere are no options available for this field.Elementary EngineeringThere are no options available for this field.Hindi Language ClassWednesdays, Time: 3:15-4:15, Age Level: 1st-6th GradeYogaThursdays, Time: 3:15-4:15, Age Level: 3-4 years oldYogaThursdays, Time, 4:15-5:15, Age Level: 4.5+SpanishFridays, Time: 3:15-4:15, Age Level: 3-6 yrs oldI understand that it is the vendor's responsibility to care for and appropriately dismiss my child from the class.*I agreeBY COMPLETING AND SUBMITTING THIS SIGNED APPLICATION, AN AGREEMENT IS MADE BY THE PARENT WITH HUDSON MONTESSORI SCHOOL TO HAVE YOUR CHILD ENROLLED FOR THE ENTIRETY OF THE WINTER/SPRING 2019 AFTER SCHOOL PROGRAMS INDICATED IN THE APPLICATION. PARENTS ARE RESPONSIBLE FOR FULL PAYMENT OF THE AFTER SCHOOL PROGRAMS IN WHICH THEIR CHILD IS ENROLLED. ALL PAYMENTS ARE NON-REFUNDABLE.*I agreeParent's Signature:*Today's Date:* This iframe contains the logic required to handle Ajax powered Gravity Forms.