2023-2024 Brookwood ASP Registration

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Student's Name #1: *

Students Grade #1: *

Students ID # for #1

Student's Name #2:

Student's Grade #2:

Students ID # for #2

Student's Name #3:

Student's Grade #3:

Students ID # for #3

Address *

Contact Phone # *

City *

Zip *

Mothers Name:

Mother's Work Phone #

Mother's Cell #

Fathers Name

Father's Work Phone #

Father's Cell #

Contact email address: *

Emergency contact other than parent and # *

Emergency & Release Information: *

In case of an emergency, release from school due to inclement weather, or early dismissal for any other reason, ASP will not operate that day. In this event, your child will be released based on prior arrangements made with your child’s teacher. However, if your child is already in ASP we will call all individuals on this form until we get in contact with someone. At that time, your child will be released to that individual. If you have any special instructions please note them below.

Restricted Pick-up:

List names of people who cannot pick up your child.

Special Instructions:

(Allergies, Diet, Medical, Etc.) Please note here if your child is in a special needs classroom.

Brookwood ASP Pick-up List

Brookwood ASP staff has my permission to release my child(ren) to the person(s) listed below. I understand that these people will be contacted if I am late picking up my child(ren) and the ASP Director is unable to contact me or due to an emergency release. ** Note: ID will be checked.

YYYY

Name #1 *

Phone #1 *

Name #2

Phone #2

Name #3

Phone #3

Name #4

Phone #4

Name #5

Phone #5

My child has permission to watch PG movies *

Yes

My child has permission to participate if we have an inflatable jump house *

Yes

Parent Acknowledgement Statement *

I have read and do understand all of the guidelines set forth in the ASP Parent Brochure. I have explained these rules to my child(ren) and have made them aware of the guidelines as well. I understand that these same rules apply to the individuals that I have authorized to pick up my child(ren) on the pick-up list located on the ASP registration form.

YYYY

Digital Signature *

Typing your name in the space provided will act as your signature.

Completed Registration *

Enrollment will be complete once:

An annual registration fee of $100 for the 1st child (Registration for families with more than one child is $100.00 for the first child, $75.00 for the 2nd and $50 for the 3rd. )

The registration fee will be posted to MyPaymentsPlus.com once the registration form is received.

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