Before & After Care Registration

Before Care & After Owl Enrichment

Registration for Kindergarten thru 8th Grades
Our Extended Day Program provides a supportive and safe environment for your child to learn, explore, share, create and play. Our trained staff encourages imagination and creativity through a variety of resources and materials for arts and crafts, science and nature exploration, and more. As children release pent-up energy through active play, they learn fair play, self-reliance, and self-confidence. In addition, the program offers supervised homework help and light snacks.

Daily Care

Before Care is available 7:00am for students in Kindergarten through 8th grade.

After Care is available from 3:15 - 6:00pm for students in Kindergarten through 8th grade.

After Owl Fees:
AM and PM Session: $45 weekly
AM Only Session: $15 weekly
PM Only Session: $30 weekly
(2nd child 15%, 3rd child 50% discount)

Registration Fee:
$25 (includes T-shirt)

Please select After Owl Program. *

Before Care ONLY - (7:00am to 8:15am) ($15.00 weekly) After Care ONLY - (3:15pm to 6pm)(2:15 to 6pm on Wednesdays)($30.00 weekly) Before Care AND After Care - ($45.00 weekly)

Child Information
Child's Name *

First Name Last Name
Birth Date

Month Day Year
Child Age
Grade Level Child is Entering *
T-Shirt Size *

Small (4/5) Medium (6/8) Large (10/12) X-Large (14/16) Adult Small Adult Medium Adult Large

Address *

Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the child prescribed an inhaler? If yes, please explain any instructions.

Authorization For Persons To Pick Up Child
Complete the information below for additional individuals who have your permission to pick up your child. The persons below must be at least 18 years of age.
Full Name

First Name Last Name
Relationship to Child
Phone Number

- Area Code Phone Number

Address

Address

START AND PICK UP TIMES

Start Time:
- 7:00am to 8:15am for Before Care
- 3:15pm to 6pm for After Care
Pick- Up Time:
- 6:00pm for full session
- A $5.00 fee will be charged if your child is not picked up by 6pm.
- In addition , a $1.00 fee will be assessed for evry minute after 6pm .
Nutrition: Breakfast and/or an afternoon snack will be provided daily for all enrolled participants. If you will be sending your child's breakfast and/or snack, please be sure that your child's lunch is clearly marked with your child's first and last name. Glass bottles/containers are not allowed.

Payments: After Owl Program Payments may be paid by check or online. Make check payable to: Deeper Root Academy

The first weeks balance is due by the FIRST day of school. We do not provide make-ups or refunds for any days missed for any reason.

PARENT STATEMENT I hereby state that the enrolling child is in good mental and physical health condition to participate in the activities provided by Deeper Root Academy's After Owl Enrichment. I understand that After Owl Enrichment has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I also agree not to hold these parties responsible in the event that my child engages in inappropriate conduct (including, but not limited to disruptive or volatile behavior in or out of the program, etc.) or becomes involved in any activity or with any persons not associated with After Owl Enrichment or its scheduled program and that After Owl Enrichment has the right to send him/her home for inappropriate conduct. I further attest that the information contained in this application is correct to the best of my knowledge. In addition, I have agreed to the policy and fee statement and agree to comply. *

I have read the PARENT STATEMENT.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature *

First Name Last Name
Date

- Month - Day Year
Date
Should be Empty:

Before Care & After Owl Enrichment