193Q-2023-24_Registration

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AFTER SCHOOL

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Best Prep After School at PS 193Q
Online Registration Form (2023-2024)

Student Information

Student's last name

Student's first name

Birthday

Sex

Male

Female

GRADE

Kindergarten

1st grade

2nd grade

3rd grade

4th grade

5TH GRADE

Class (if known)

Home address

My child is:

New to Best Prep

Returning student

Any siblings attending BPA (Full name, Grade)?

guardian Information

PARENT/GUARDIAN #1

Parent/Guardian #1 Full name

Relationship to child:

Parent/Guardian #1 Cell:

Parent/Guardian #1 Work:

Parent /Guardian #1 Email address

PARENT/GUARDIAN #2

Parent/Guardian #2 Full name

Relationship to child:

Parent/Guardian #2 Cell:

Parent/Guardian #2 Work:

Parent /Guardian #2 Email address

EMERGENCY CONTACT

Emergency contact name:

Emergency phone

Emergency address

SAME A HOME

program details

PROGRAM INFORMATION

MONDAY - FRIDAY
2:15 - 5:30 PM
$395/ 4 WEEKS
$60 REGISTRATION FEE
10% SIBLING DISCOUNT

Payment method preference

Zelle

Check

Credit card (3.837% fee applies)

Cash

Desired Start Date (Program starts 9/18)

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's health information

Allergies (mark NA if not applicable):

Please 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 students who need Epinephrine Auto-Injector (EPIPEN) and/or inhaler on site:

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

PROGRAM POLICY

ENROLLMENT CONTRACT

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

Best Prep policy

I have read and agree to the terms & conditions

Adverse Childhood Experiences (ACES)

What is Adverse Childhood Experiences (ACEs)?
Learn more by clicking the link below.

Adverse Childhood Experiences (ACEs)

Anything else you would like us to know?

BEFORE YOU SUBMIT

Please review all information to make sure everything is accurate.

Registration is NOT complete without first payment

Upon submission, one of our representatives will contact you to complete your registration process.

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Best Prep After School at PS 193Q Online Registration Form (2023-2024)