PLEASE CONTACT YOUR CLUB VENDOR DIRECTLY FOR REGISTRATION AND FEES. The Clubs Permission Form covers all clubs your child(ren) is registered in for one school year.

Click to access:

  • Download the form in a .PDF format

    or
  • Use the online form below

Student's Name: *
Name of School: *
Gender:
Age:
Child's Birthday:
Grade Level:
Teacher:
Address: *
Mother's Name:
Mother's Home #:
-
Mother's Work #:
-
Mother's Cell #:
-
Mother/Legal Guardian's E-mail:
Father's Name:
Father's Home #:
-
Father's Work #:
-
Father's Cell #:
-
Father/Legal Guardian's E-mail:
Family E-mail:
Does your child have any physical limitations or allergies?
If yes, please list:
My child will be picked up by:

The child will be released only to the person(s) authorized, in writing, by the custodial parent(s) or legal guardian(s) and is authorized to remove the child from after-school clubs in cases of illness, accident or emergency.  If for some reason the custodial parents(s) or legal guardian(s) cannot be reached the school should contact:

Contact relationship to the child:
Contact 1 Name:
Contact 1 Address:
Contact 1 Home #:
-
Contact 1 Cell #:
-

I give permission for my child to participate in the following after school clubs:

Club 1: *
Club 1 Meeting Location/Day/Time:
Club 2:
Club 2 Meeting Location/Day/Time:
Club 3:
Club 3 Meeting Location/Day/Time:
I verify that the information on this enrollment form is complete and accurate: *
Parent Signature: *


Field Trip Permission

I give permission for my child to attend field trips offered by Springdale Parks after school Clubs.


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.


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.


Dismissal Permission

I understand that if I do not pick up my child at the end of the club meeting sessions, I release/pick up them to After School Classe’, Spark’s after school program. The drop in fee is $22.00.
Date:

 

Back to top