After School Club Registration

Parent Name

First

Last

Parent Email

Parent Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship to Student(s)

School Name

How Many Children Will Be Attending?

Child #1 Name

First

Last

Child #1 Grade and Teacher's Name

Child #2 Name

First

Last

Child #2 Grade and Teacher's Name

Child the

Child #3 Name

First

Last

Child #3 Grade and Teacher's Name

Child #4 Name

First

Last

Child #4 Grade and Teacher's Name

Please call us at (305) 453-7030 or send us a message if you plan on having more than four children attend.

Will These Students Be Attending the Same School?

Yes
No

Emergency Contact Name

First

Last

Emergency Contact Phone

Is There Anything Else We Should Know? Health Concerns, Allergies, Special or Behavioral Needs…

Please Read

I understand

I understand that my child(ren) will be dismissed from the After School Club at a designated time. It is my responsibility to pick them up at that time. CRF will allow a 15 minute grace period beyond the designated dimissal time. After the 15 minutes grace period, I am responsible to pay $5 cash directly to the instructor for every 15 minutes that I am late.

Total Cost

Price: $0.00

Secure Payment

Card Number

Expiration

/

Security Code

Join the Club!

Help Restore Our Reefs