After School Program Annual Registration Form

This form must be filled out only once per year by any family who will be utilizing the BJAMS After School Program at any point in the school year.

Students must be registered for the After School Program in order to attend.
Student Name(s) and Grade(s)*
Please list all first and last names and grades of the children in your family who will attend ASP this year.
Emergency Contacts
You must list two emergency contacts in the event that a parent cannot be reached.
Emergency Contact #1*
First Last
Phone*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Emergency Contact #2*
First Last
Phone*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Medical Information
Please list any food or insect allergies your child may have as well as any medical condition (ie.asthma) your child has that may be important for ASP Staff to be aware of.
Consent*
I agree to the following:
I authorize my child to attend the BJAMS After School Program and to take part in all activities. I give permission for people I have listed both on this form and in my FACTS portal to pick up my child. I understand that these people will be asked for identification if not recognized by the staff. I agree to all of the policies and billing procedures of the After School Program.
Date*
MM slash DD slash YYYY
CAPTCHA

Students must be registered for the After School Program in order to attend.