First Coast Taekwondo AFTER SCHOOL PROGRAM COVID
Kickin' Kids After School Program Registration 2020-2021
GENERAL INFORMATION -

If a school closes due to COVID 19, we plan on being open from 8am-5:30pm. The weekly fee for when schools are out due to COVID 19 will be $160 for parents that want their child to attend. During these days, we will provide students a safe place to conduct their online classes with available teachers on hand to Supervise and offer some assistance (technical and otherwise) to the students as needed.

COVID 19. I understand that I am registering my child to attend the First Coast Taekwondo After School Program during Covid 19 and the inherent risks with this decision. Given the nature of what we do, it is inevitable that students will come in contact with each other. However, we are taking every precaution we can to provide a safe environment for your family.

I understand and agree to First Coast Taekwondo updating its policies as needed in order to comply with City, State and CDC guidelines as needed and without notice or need for re-authorization.

The After School Program is limited 25 students at the moment. Students will be treated as “households,” so they won’t have to socially distance, but they will have to socially distance as needed and directed by teachers (example - field trips)

We will wash and sanitize our hands a LOT more, and we will also clean a lot more as well.

If your camper is at higher risk for COVID-19 complications, please email us at FCTfrontdesk@hotmail.com as soon as possible. We recommend that parents/guardians of higher-risk students consult their child’s medical provider to assess the risk before attending. High-risk conditions include (but aren’t limited to): Hemoglobin disorders Immunocompromisation Liver disease Serious heart conditions Severe obesity.
  • STUDENT'S INFORMATION

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  • Please select your child's school for the 20201 school year. If the his/her school is not listed, select other and put their school name in the comment field.
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  • Bank Name/Type of CC
    Routing # (Bank Draft Only)
    Bank Account # or Credit Card #
    Expiration Date (Credit Card Only)
    If you would like to enjoy the convenience of automatic recurring billing, simply complete the Bank Draft or Credit Card Information section below and sign the form. All requested information is required. Upon approval, we will automatically bill your bank account or credit card for the amount indicated and your total charges will appear on your monthly statement. You may cancel this automatic billing authorization by sending written notice in such time (no less than two weeks prior to your next scheduled payment date) and in such manner to allow both First Coast Taekwondo and the receiving financial institution a reasonable opportunity to act on it.

    Please note this form is SSL secure. In addition, the Auto Bank Draft & Auto Credit Card Payment Information field is an encrypted field.

    You may cancel this automatic billing authorization by sending written notice in such time (no less than two weeks prior to your next scheduled payment date) and in such manner to allow both First Coast Taekwondo and the receiving financial institution a reasonable opportunity to act on it.

    Recurring Automatic Payment Authorization Terms:
    This payment authorization is to remain in full force and effect until I, the account/card holder, notify First Coast Taekwondo of its cancellation by sending written notice in such time and in such manner to allow both First Coast Taekwondo and the receiving financial institution a reasonable opportunity to act on it. Accountholder by execution of this agreement waives any right to receive advance notice of the deduction associated with the services provided by First Coast Taekwondo or Agent and further authorizes a service charge not to exceed $35 for returned, unpaid or declined transactions from the Bank and other fees and charges to be paid under this agreement. Accountholder further warrants that he/she is the owner or authorized signer of the referenced account and has full authority to enter into this agreement.

  • (Select N/A if selected pay in person payment option)
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    If selected pay in person tuition rate, enter 11/11/1111
  • (Select N/A if selected pay in person payment option)

    You may cancel this automatic billing authorization by sending written notice in such time (no less than two weeks prior to your next scheduled payment date) and in such manner to allow both First Coast Taekwondo and the receiving financial institution a reasonable opportunity to act on it.
  • PARENT INFORMATION

    Note: If one of the fields does not apply, put N/A. Thank you.
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  • AUTHORIZED PICK-UP (other than parent/guardian)

  • Authorized Pick-Up (other than parent/guardian)

    The child will be released only to the parent(s) authorized, or in the manner authorized in writing, by the custodial parent(s) or legal guardians(s). The following people are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason the custodial parent(s) or legal guardian(s) cannot be reached:
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  • AUTHORIZATIONS

  • I agree to all the above conditions and terms of service.
  • I agree to all the above conditions and terms of service.
  • I agree to all the above conditions and terms of service.
  • AGREEMENT TO PAY

  • I agree to all the above conditions and terms of service.
  • Parent or Guardian SSN
    Parent or Guardian DL#
    DL State Issued
  • General Policies

  • I agree that I have received the above items and that the information on this enrollment form is complete and accurate.
  • I agree to all the above conditions and terms of service.
  • I agree to all the above conditions and terms of service.
  • I agree to all the above conditions and terms of service.
  • I agree to all the above conditions and terms of service.
  • I agree to all the above conditions and terms of service.
  • I agree to all the above conditions and terms of service.
  • This signature must be that of the individual "signing" this document electronically, otherwise it constitutes forgery under s.831.06, Florida Statutes
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  • I agree to all the above conditions and terms of service.