130_OnlineRegistration | BPA OF NY

Register for after school online (PS 130)

Person completing registration form (First name, Last name):

Relationship to child:

Student Information

Student's name

Birthday

Sex

Male

Female

Grade/ Class #:

Any siblings attending BPA (Full name, Grade)?

Home address

Home phone

Guardian Information

Parent/Guardian #1

Parent/Guardian #1 Full name

Relationship to child:

Parent/Guardian #1 Cellphone:

Parent/Guardian #1 Work:

Parent /Guardian #1 Email address

Parent/Guardian #2

Parent/Guardian #2 Full name

Relationship to child:

Parent/Guardian #2 Cellphone:

Parent/Guardian #2 Work:

Parent /Guardian #2 Email address

Emergency Information

Emergency contact name:

Emergency phone

Emergency address

Program details

My child is:

New to Best Prep

Returning student

Program selection (every 4 weeks):

Program A : Academic Enrichment ($ 540) until 6:00 pm

Program B : Consecutive Review ($440) until 6:00 pm

Program C+ : HW Assistance + Review ($395) until 6:00 pm

Program C : HW Assistance + Review ($335) until 5:00 pm

Payment method preference (first payment only)

Paypal

Zelle

Check

Credit card (3.837% surcharge applies)

Desired program start date. (Earliest start date: 10/21/21)

Dismissal Information

My child may be picked up by the following person(s):

My child may NOT be picked up by (mark as NA if unapplicable):

I give permission for my child to walk home alone at dismissal (Signature required)

Student Health Information

Allergies (mark NA if not applicable):

Plesae check all that applies to your child:

Asthma

Behavorial/Emotional issues

Convulsions/Seizures

Diabetes

Corrective device (glasses, hearing aid, etc.)

N/A

Does your child take medication for any condition or illness? (Mark NA if not applicable)

Are there any activities your child can NOT participate in? (Mark as NA if not applicable)

For children who need Epinephrine auto-injector and/or inhaler on site:

I allow my child to carry his/her epi-pen and/or inhaler. (Signature required):

Program Policy

Please review Best Prep's Program Enrollment contract and policies by clicking the link below.

What is Adverse Childhood Experiences (ACEs)? Click on the link below to learn more.

Adverse Childhood Experiences (ACEs)

I have read and agree to the terms & conditions

Anything else you would like us to know?

Please review all information to make sure everything is accurate.

Please note registration is not finalized until we contact you and payments are received.

Upon submission, one of our representatives will reach out to complete the registration process.

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