Angier After School Program Online Registration

Student #1

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

School*

Grade Level in Sept. 2024*

Physical Description: height, weight, hair & eye color, skin tone, other distinguishing features*

Does your child have an IEP, or are they currently being evaluated for an IEP?*

In what areas may your child need supports or other accommodations while at AASP?*

Please list any allergies or chronic health conditions that MAY REQUIRE MEDICATION while at AASP:*

List any other conditions or dietary restrictions that WILL NOT require medication while at AASP:*

Child's physician & phone number:*

Other than Parent/Guardian #1 & #2, Name and phone # of ALL adults authorized to pick up your child:*

Siblings (names and ages):

Languages spoken at home:

Hobbies and interests:

Pronouns:

To apply, select each day you are interested in enrolling, based on your child's grade. A two-day minimum/child is required.

You will be charged a $50/family registration fee upon submitting this form. This fee is non-refundable, regardless of enrollment status. This fee may be waived for current waitlist families who paid a fee last year, but were not enrolled. Please see our website for details.

Families with multiple children enrolled a min. of 3 days/each will receive a 5% discount for the second and any additional children.

If your family requires financial assistance, email us at info@angierafterschool.com to request a financial aid application no later than Friday, April 22nd. Financial aid applications are due by May 10th at 6pm.

See our website for detailed information about the enrollment process and policies, including an explanation of our Priority Guidelines: angierafterschool.com/enroll

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

School*

Grade Level in Sept. 2024*

Physical Description: height, weight, hair & eye color, skin tone, other distinguishing features*

Does your child have an IEP, or are they currently being evaluated for an IEP?*

In what areas may your child need supports or other accommodations while at AASP?*

Please list any allergies or chronic health conditions that MAY REQUIRE MEDICATION while at AASP:*

List any other conditions or dietary restrictions that WILL NOT require medication while at AASP:*

Child's physician & phone number:*

Other than Parent/Guardian #1 & #2, Name and phone # of ALL adults authorized to pick up your child:*

Siblings (names and ages):

Languages spoken at home:

Hobbies and interests:

Pronouns:

To apply, select each day you are interested in enrolling, based on your child's grade. A two-day minimum/child is required.

You will be charged a $50/family registration fee upon submitting this form. This fee is non-refundable, regardless of enrollment status. This fee may be waived for current waitlist families who paid a fee last year, but were not enrolled. Please see our website for details.

Families with multiple children enrolled a min. of 3 days/each will receive a 5% discount for the second and any additional children.

If your family requires financial assistance, email us at info@angierafterschool.com to request a financial aid application no later than Friday, April 22nd. Financial aid applications are due by May 10th at 6pm.

See our website for detailed information about the enrollment process and policies, including an explanation of our Priority Guidelines: angierafterschool.com/enroll

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

School*

Grade Level in Sept. 2024*

Physical Description: height, weight, hair & eye color, skin tone, other distinguishing features*

Does your child have an IEP, or are they currently being evaluated for an IEP?*

In what areas may your child need supports or other accommodations while at AASP?*

Please list any allergies or chronic health conditions that MAY REQUIRE MEDICATION while at AASP:*

List any other conditions or dietary restrictions that WILL NOT require medication while at AASP:*

Child's physician & phone number:*

Other than Parent/Guardian #1 & #2, Name and phone # of ALL adults authorized to pick up your child:*

Siblings (names and ages):

Languages spoken at home:

Hobbies and interests:

Pronouns:

To apply, select each day you are interested in enrolling, based on your child's grade. A two-day minimum/child is required.

You will be charged a $50/family registration fee upon submitting this form. This fee is non-refundable, regardless of enrollment status. This fee may be waived for current waitlist families who paid a fee last year, but were not enrolled. Please see our website for details.

Families with multiple children enrolled a min. of 3 days/each will receive a 5% discount for the second and any additional children.

If your family requires financial assistance, email us at info@angierafterschool.com to request a financial aid application no later than Friday, April 22nd. Financial aid applications are due by May 10th at 6pm.

See our website for detailed information about the enrollment process and policies, including an explanation of our Priority Guidelines: angierafterschool.com/enroll

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

School*

Grade Level in Sept. 2024*

Physical Description: height, weight, hair & eye color, skin tone, other distinguishing features*

Does your child have an IEP, or are they currently being evaluated for an IEP?*

In what areas may your child need supports or other accommodations while at AASP?*

Please list any allergies or chronic health conditions that MAY REQUIRE MEDICATION while at AASP:*

List any other conditions or dietary restrictions that WILL NOT require medication while at AASP:*

Child's physician & phone number:*

Other than Parent/Guardian #1 & #2, Name and phone # of ALL adults authorized to pick up your child:*

Siblings (names and ages):

Languages spoken at home:

Hobbies and interests:

Pronouns:

To apply, select each day you are interested in enrolling, based on your child's grade. A two-day minimum/child is required.

You will be charged a $50/family registration fee upon submitting this form. This fee is non-refundable, regardless of enrollment status. This fee may be waived for current waitlist families who paid a fee last year, but were not enrolled. Please see our website for details.

Families with multiple children enrolled a min. of 3 days/each will receive a 5% discount for the second and any additional children.

If your family requires financial assistance, email us at info@angierafterschool.com to request a financial aid application no later than Friday, April 22nd. Financial aid applications are due by May 10th at 6pm.

See our website for detailed information about the enrollment process and policies, including an explanation of our Priority Guidelines: angierafterschool.com/enroll

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Gender

Birth Date*

Additional Info

School*

Grade Level in Sept. 2024*

Physical Description: height, weight, hair & eye color, skin tone, other distinguishing features*

Does your child have an IEP, or are they currently being evaluated for an IEP?*

In what areas may your child need supports or other accommodations while at AASP?*

Please list any allergies or chronic health conditions that MAY REQUIRE MEDICATION while at AASP:*

List any other conditions or dietary restrictions that WILL NOT require medication while at AASP:*

Child's physician & phone number:*

Other than Parent/Guardian #1 & #2, Name and phone # of ALL adults authorized to pick up your child:*

Siblings (names and ages):

Languages spoken at home:

Hobbies and interests:

Pronouns:

To apply, select each day you are interested in enrolling, based on your child's grade. A two-day minimum/child is required.

You will be charged a $50/family registration fee upon submitting this form. This fee is non-refundable, regardless of enrollment status. This fee may be waived for current waitlist families who paid a fee last year, but were not enrolled. Please see our website for details.

Families with multiple children enrolled a min. of 3 days/each will receive a 5% discount for the second and any additional children.

If your family requires financial assistance, email us at info@angierafterschool.com to request a financial aid application no later than Friday, April 22nd. Financial aid applications are due by May 10th at 6pm.

See our website for detailed information about the enrollment process and policies, including an explanation of our Priority Guidelines: angierafterschool.com/enroll

Enroll in Classes

Select Class *

Registration

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

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

Account Information

eCheck/Bank Draft

Registration

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

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

Account Information

eCheck/Bank Draft

Required Policies

(Show-Hide Details)