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LDA AFTER SCHOOL REGISTRATION FORM
PLEASE READ AND COMPLETE ALL APPLICABLE QUESTIONS CAREFULLY!!!
This information is critical in providing the best experience to you and your child. Once you have completed the Registration Form, you may select the No School Days Product and complete your enrollment.
PLEASE NOTE: ALL FAMILIES THAT REGISTER FOR THE LDA AFTER SCHOOL PROGRAM AND DO NOT ALREADY RIDE THE BUS THAT STOPS AT THE COMMUNITY CENTER WILL NEED TO COMPLETE A BUS STOP CHANGE FORM. THIS LINK IS PROVIDED BELOW.
STUDENT INFORMATION
Name
*
First
Last
Age
*
Birthdate
*
Current Grade....
*
Current School
*
Student Allergies?
*
No
Yes
Special Medical/Medication Considerations?
*
No
Yes
If you answered 'Yes' above, please tell us more about any allergies your child has.
*
If you answered 'Yes' above, please provide additional information that LDA Instructors would need to know to better interact with your child.
*
PARENT/GUARDIAN INFORMATION
Parent/Guardian 1 Name
*
First
Last
Phone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Parent/Guardian 2 Name
*
First
Last
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Please select the days your would like to register your child for early release days. ($30 per day, paid at check out)
*
Friday, September 1st
Friday, October 13th
Thursday, October 26th
Friday, December 8th
Thursday, December 21st
Friday, February 16th
Friday, March 2nd
Thursday, March 15th
Thursday, May 24th
Will anyone other than the Parents/Guardians list above be permitted to pick up your child?
*
Yes
No
How did you hear about us?
*
Word of mouth
Web search
PeachJar
Other
If you answered 'Yes' to the above question, please list First/Last Names, Relation to Family, & Phone contact information for all individuals authorized to pick up your child. For security purposes, we will be requesting photo ID for any individuals below at the time of drop off/pick up.
*
If you selected 'Other' above, please tell us where you heard about us in the box below:)
*
IF YOUR CHILD DOES NOT ALREADY GET OFF THE BUS AT THE OLIVETTE COMMUNITY CENTER, PLEASE COMPLETE THE BELOW FORM.
drive.google.com/file/d/0B8FMrswJET_NcllIOXVjdW9JOW8/view
Submit Information and Complete Registration!!!
✕
