163_OnlineRegistration | BPA OF NY

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Register Online (BPA at PS 163)
在线注册（PS 163 的 BPA）

Person completing registration form (First name, Last name) [填写注册] :

Relationship to child [关系到孩子] :

Student Information [学生信息]

Student's name [学生的名字] :

Birthday [生日] :

Sex [男/女] :

Male [男]

Female [女}

Grade [年级] :

Any siblings attending BPA? (Full name, Grade) [有没有参加 BPA 的兄弟姐妹?（姓名、年级）] :

Home address [地址] :

Home phone [电话号码 ] :

Guardian Information [ 监护人信息 ]

Parent/Guardian #1 [家长/监护人 #1]

Parent/Guardian #1 Full name [家长/监护人 #1 姓名] :

Relationship to child [关系到孩子] :

Parent/Guardian #1 Cellphone [家长/监护人 #1 手机] :

Parent/Guardian #1 Work [家长/监护人 #1 工作电话] :

Parent /Guardian #1 Email [家长/监护人 #1 电子邮件地址] :

Parent/Guardian #2 [家长/监护人 #2]

Parent/Guardian #2 Full name [家长/监护人 #2 姓名] :

Relationship to child [关系到孩子] :

Parent/Guardian #2 Cellphone [家长/监护人 #1 手机] :

Parent/Guardian #2 Work [家长/监护人 #2 工作电话] :

Parent /Guardian #2 Email [家长/监护人 #2 电子邮件地址] :

Emergency Information [紧急信息]

Emergency contact name: [紧急联络名字] :

Emergency phone [紧急电话号码] :

Emergency address [紧急地址] :

Program details [节目信息]

My child is [我的孩子是] :

New to Best Prep [BPA 新手]

Returning student [对 BPA 并不陌生]

Homework assistance + review
Program start date: Oct 4, 2021
Dismissal - 5:45 PM
$18/ day | Registration fee $60
Cold/hot meal included

Tuition for each month
October 2021 | $342
November 2021 | $324
December 2021 | $306
January 2022 | $360
February 2022 | $252
March 2022 | $414
April 2022 | $270
May 2022 | $360
June 2022 | $270

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家庭作业协助+复习
计划开始日期：2021 年 10 月 4 日
解雇 - 下午 5:45
$18/天 | 注册费$60
包括冷/热餐

本月学费
十月 | $342
十一月 | $324
十二月 | $306
一月 | $360
二月 | $252
三月 | $414
四月 | $270
五月 | $360
六月 | $270

Dismissal Information [解雇信息]

My child may be picked up by the following person(s) [我的孩子可能会被以下人员接走] :

My child may NOT be picked up by (mark as NA if unapplicable) [我的孩子可能不会被以下人员接走（如果不适用，标记为 NA)] :

I give permission for my child to walk home alone at dismissal (Signature required) [我允许我的孩子在放学时独自走路回家（需要签名）]

Health Information [学生健康信息]

Allergies (mark NA if not applicable) [过敏（如果不适用，请标记为 NA)] :

Plesae check all that applies to your child [请检查所有适用于您孩子的信息] :

Asthma [哮喘]

Behavorial/Emotional issues [行为/情绪问题]

Convulsions/Seizures [抽搐/癫痫发作]

Diabetes [糖尿病]

Corrective device (glasses, hearing aid, etc.) [矫正装置（眼镜、助听器等）]

N/A [不适用]

Does your child take medication for any condition or illness? (Mark NA if not applicable) [您的孩子是否因任何病症或疾病服用药物？（如果不适用，请标记 NA）] :

Are there any activities your child can NOT participate in? (Mark as NA if not applicable) [您的孩子是否有不能参加的活动？（如果不适用，标记为 NA）] :

For children who need Epinephrine auto-injector and/or inhaler on site:
[对于需要现场肾上腺素自动注射器和/或吸入器的儿童] :

I allow my child to carry his/her epi-pen and/or inhaler. (Signature required) [我允许我的孩子携带他/她的 Epi-pen 和/或吸入器。（需要签名）] :

Program Policy [计划政策]

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

[请单击下面的链接查看 Best Prep 的计划注册合同和政策。]

BPA policy [政策]

I have read and agree to the terms & conditions. [我已阅读并同意条款和条件]

Anything else you would like us to know? [你还有什么想让我们知道的吗？] :

Please review all information to make sure everything is accurate.
请检查所有信息以确保一切准确无误。

Please note registration is not finalized until payments are received.
请注意，在收到付款之前，注册不会完成。

* You will not receive a confirmation after submitting the application from our website, but please wait for an email from one of our representatives.
* 从我们的网站提交申请后，您将不会收到确认，但请等待我们一位代表的电子邮件。

We're sorry.
We are currently at full capacity.
Please request to be on the waitlist.
718-961-2200.

Please text child's name, school number, and your email address. We will notify you when we are ready to take registration.

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