NYCID Online Registration

Registration

Already a customer? Click here to login.

NYCID REGISTRATION FORM

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info*

Health Insurance Carrier

Contact #1

PARENT #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell #

Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

PARENT#2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Class*

Authorized Pick up #1*

Authorized Pick up #2*

Authorized Pick up #3

Authorized Pick up #4

After submitting your registration form online the NYCID after-school accounts manager will receive your information and post any discounts if due in your account. This may take up to 48 hours to see your actual account balance. Please check your parent portal regularly and pay your bill promptly.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Class*

Authorized Pick up #1*

Authorized Pick up #2*

Authorized Pick up #3

Authorized Pick up #4

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Class*

Authorized Pick up #1*

Authorized Pick up #2*

Authorized Pick up #3

Authorized Pick up #4

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Class*

Authorized Pick up #1*

Authorized Pick up #2*

Authorized Pick up #3

Authorized Pick up #4

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade*

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Class*

Authorized Pick up #1*

Authorized Pick up #2*

Authorized Pick up #3

Authorized Pick up #4

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Permission to attend/Assumption of Risk/Release of Liability

I hereby give permission for my child, named above, to attend the NYCID After-School Program. I certify that my child has had a physical exam within the last year, has a physician's approval to participate in sports without restrictions and is covered by a medical insurance program. I acknowledge that New York Center for Interpersonal Development will not assume any responsibility or liability for personal injury.

In the event NYCID is unable to reach a parent, guardian or any emergency contact, I hereby give permission for my child, named above, to be transported to the nearest hospital for treatment in case of an accident or emergency.

I've read the above and agree.

Photo Consent

I hereby consent to my child's participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes for NYCID's purposes including use in print and other forms of media to promote programs and other non-commercial purposes of the program.

If you do not give permission for photo release please send in a letter to the Site Supervisor stating that you do not give permission for photo consent.

I've read the above and agree.

Payment Policies

Registration and enrollment fees are non-refundable. Monthly fees for after-care (2:20pm-6pm program) are due on the 1st of each month and are paid to reserve an entire month of child care, irrespective of the actual number of days the child attends. Any fees that are not paid by the 7th of the month will result in a $15.00 late fee and immediate suspension of child care services until the fees are paid in full. Club payments are due upon enrollment, before the class begins. If fee is not paid before the first class a $15 late fee will incurred and your child will not be admitted to the club. As of October 1st the only acceptable forms of payment are online Bank Payment, or Credit Card payment. There will be a monthly online Portal Fee of $5.00 per family for After-Care students.

I've read the above and agree.

Medication and Medical Emergencies

As per the Department of Health, each child needs a current physical/medical signed and stamped by their medical doctor on file with the Program. No child will be admitted to the program before this form is submitted. If you have a current form (physical done within a year of the current date) on file with the school you must request a copy of it and submit it to the Supervisor of the After-School Program.

The NYCID After-School Program is only authorized to administer over-the-counter topical ointments, lotions, and creams, sprays, including sunscreen products and topically applied insect repellent.
We are also authorized to administer epinephrine auto-injectors, diphenhydramine in combination with epinephrine auto-injector, asthma inhalers and nebulizers. There will always be staff on site that are trained in the administration of these medications. If your child is prescribed any of the authorized medications you must indicate in the online registration medical section and submit the required consent forms and health care plan, located on our website, to the NYCID After-School Site Supervisor upon registration. All other medical needs with be addressed by a staff person certified in first aid.

If a child has any of the following conditions, the parent will be notified to pick up the child immediately: Contagious Disease, Fever over 100 F, Vomiting or Diarrhea, Accident Requiring Medical Attention.

In case of accident or illness, parents of the child will be called immediately. In serious cases, the child will be taken to one of the local hospitals by emergency vehicle for treatment and the parents will be called as soon as possible.

I've read the above and agree.

Behavior Management Policy

NYCID Program participants are entitled to a pleasant and harmonious environment. NYCID staff is committed to providing a safe, positive, and structured environment for all children in the program. Although our programs are a different setting than the regular school day, appropriate student behavior is still expected. Please review the following rules and consequences that will guide NYCID programs.
Policies:
1. Show respect at all times.
2. Move appropriately throughout school building during program hours.
3. Follow instructions set forth by NYCID staff.
4. Refrain from damaging any school property.
5. Refrain from disruptive behavior, fighting, violence of any kind, inappropriate language, and bullying.
6. Comply with any and all other regulations set forth by the NYCID Program Director.
Consequences:
NYCID programs will make every effort to communicate with parents when a disciplinary action needs to be taken. Please know that all rules will be reviewed with students at the beginning of the school year. It is imperative that both students and parents understand the expectations of the NYCID program as well as the potential consequences.
Reasonable efforts will be made to assist children to adjust to the Program setting. Disruptive behavior will be dealt with in the following manner:
1. REDIRECTION: A misbehaving child will be given a verbal cue as a first attempt to redirect their behavior.
2. SIT OUT: If the child continues misbehaving he/she will be removed from the activity to cool off and reflect on behavior.
3. DOCUMENT: If a child continues to misbehave the behavior will be documented and parents will be notified.
4. SUSPENSION: If misbehavior continues after the previous steps are taken, and the behavior warrants it, a site supervisor may issue a suspension for up to one week from program depending on the severity of the situation.
5. EXPULSION: After following steps 1-4 the child will be suspended from the program indefinitely.
A child may be dismissed from the program indefinitely if the behavior warrants it at the discretion of the Site Supervisor and approval from the Afterschool Programs Coordinator.
If the severity of a problem is great enough that it could endanger the safety of the child or other children in the Program, discharge can be effective immediately.

I've read the above and agree.

Dismissal Procedures

The NYCID After-Care Program ends promptly at 6:00pm (Club end times are listed). Only persons indicated on your child's registration form are authorized to pick them up. Please send in written notification signed by a parent to the program director if you wish for someone without proper authorization to sign out your child.

Any child that remains after 6:00pm will be put on late pick-up alert. a late fee of $1.00 per minute will be charged for a pickup after 6:00 p.m. If a child is picked up before 6:05 p.m., the late fee will be waived. If a child is picked up after 6:05 p.m., the late fee will be assessed from 6:00 p.m. An entry in the late pickup log will detail the time of pickup and the amount due. Late fees will be added to the child's tuition bill.
After the third occurrence of a late pickup, the five-minute grace period will be revoked. Continual late pickup may result in a child's suspension or removal from the program without refund.
There is no security past 6:00pm and personnel do not get paid past 6:00pm. In the event that a child is not picked up and no parent/guardian can be reached the local police precinct will be called and they will take your child back to the nearest precinct

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments