PS 154 After School Program Online Registration

Registration

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PS 154 After School Program and Camp Summer Friendship Registration.

Please use this form to register your child for our After School extended day program and enrichment clubs.

For billing questions please contact Susan Dominguez 154billing@gmail.com.

For changes to your schedule go here https://docs.google.com/forms/d/16VljWNMOSAoPTK1EAxawqZXcJFnm22EZ_QmUZMV8Yzs/edit

* denotes required fields

Family Information

Student Last Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Medications

Primary Doctor

Click on SEARCH to begin viewing ALL available classes or choose filters to view by TYPE or DAY Clicking on class will add to registration page

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Medications

Primary Doctor

Click on SEARCH to begin viewing ALL available classes or choose filters to view by TYPE or DAY Clicking on class will add to registration page

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Medications

Primary Doctor

Click on SEARCH to begin viewing ALL available classes or choose filters to view by TYPE or DAY Clicking on class will add to registration page

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Medications

Primary Doctor

Click on SEARCH to begin viewing ALL available classes or choose filters to view by TYPE or DAY Clicking on class will add to registration page

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities

Special Needs

Allergies

Medications

Primary Doctor

Click on SEARCH to begin viewing ALL available classes or choose filters to view by TYPE or DAY Clicking on class will add to registration page

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

Registration

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)