After School Club Registration

Dear Parents and Trainee (Applicant):

Thank you for your interest our STEM based After School Club.  Please fill out this application form completely.  Your child will not be registered until the registration fee and first week payments are made. The Club meets 2 days per week at the school.   Your child may also be invited to be part of the competition computer science team or the data science club.

Parent\Guardian Name:*
Additional Parent/Guardian Name:
E-mail:*
Primary Contact Phone:*
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Secondary Contact Phone:
-
Address:*
Youth's Name:*
Youth's E-mail:
Student's Age:*
School Attending:*
Grade:*
Second Child:
Second Child E-mail:
Second Child's Grade
Second Child Age:
School Attending:(1)
Third Child:
Third Child E-mail:
Third Child Age:
School Attending:(2)
Third Child's Grade:
Emergency Contact 1 Info:*
Emergency Contact 1 Phone:*
-
Emergency Contact 2 Name:
Emergency Contact 2 Phone:
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Authorized Person for Pickup:*
Relationship:*
Primary Authorized Person for Pickup:
Primary Relationship :
Secondary Authorized Person for PickUp:
Relationship :

Payments/ Fees:

Weekly fee for Kids Tech U is $40.00

Days:Tuesday & Thursday.

Please make weekly payments online through website on the parent information page.

Don't forget to include your child's (Trainee’s) name as the account number.

Registration fee of $20.00 and the payment for the starting week, must be paid prior to or on first day of attendance.

10% Sibling & Military discounts apply.� Payment for each week, must be made by the Friday of the previous week. No later than the Monday of current program week. Late payments are subject to a $5 late fee.��

Any Trainee with unpaid balance or excessive late fees may be subject to disenrollment from the program.

We understand that “life happens” and things may occur that make it difficult to make payments on time or at all.

If a student is out for a week or more with an illness or family emergencies; the student will not be charged for that week/or weeks after written communication to info@kidstechu.com.   The student will NOT have to pay a new registration fee to return to the program.� Please communicate with us, so that we may see if there is any way to continue our partnership.

Payments are paid weekly. If a student misses a day or two out of the program week, due to early check out or other reasons; they will not be reimbursed a daily fee. We require a 2-week notice for students that no longer wish to participate in the program.�


Supervision:

Your child will be supervised in the program fromstart of day 3:40 PM until 5:45 PM.All Trainees must be picked up on time. Trainees may only be picked up by authorized persons.

Starting at 5:50 PM, if children are not picked up, they will be automatically enrolled in the school's after school program and charged based on the school's fee schedule.

By typing your full name below, you understand and accept Kids Tech U program policies; and agree to comply with its terms.

Registration Fee ($20 per child)*
 $ 
Weekly Tuition Fee ($40 per Child )*
 $ 
Total Due:
Signature Name:*
Date of Signature:*
Word Verification: