EmailMe Form - PSN After School (Off Campus) 19-20

How Did you hear about us?

My child attended Summer camp 2019

My child has used ALM Afterschool before

Online (Google)

Social Media (Facebook & Instagram)

Flyer from Program/School

A friend told me

Other

PARENTS INFORMATION

Mother's Full Name *

Father's Full Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Mother's Cell Phone *

### - ### - ####

Father's Cell Phone

### - ### - ####

Mother's Email #1 *

Father's Email #2

CHILD INFORMATION

Enrollment *

I am enrolling 1 child

I am enrolling 2 children

I am enrolling 3 children

#1: Childs First Name *

#1: Childs Last Name *

#1: Date of Birth *

#1: School Name *

#1: Grade *

#1: Teachers Name *

#1: Will your First Child need School Pick up? *

Yes

No

#1: Food Allergies?

#1: Medical Conditions

CHILD #2 INFORMATION

#2: Childs First Name

#2: Childs Last Name

#2: Date of Birth

#2: School Name

#2: Grade

#2: Teachers Name

#2: Will your Second Child need School Pick up?

Yes

No

#2: Food Allergies?

#2: Medical Conditions

CHILD #3 INFORMATION

#3: Childs First Name

#3: Childs Last Name

#3: Childs Date of Birth

#3: School Name

#3: Grade

#3: Teachers Name

#3: Will your Third Child need School Pick up?

Yes

No

#3: Food Allergies?

#3: Medical Conditions

AUTHORIZED PICK UP

Who do you authorize to pick up your child after the program?

please list the names of the people you authorize to pick up your child.
(please note Drivers license needs to be presented)

REFERRALS

Who Referred you?

How did you hear about our program?

Who did you Refer?

For every person you refer, you will receive $5 voucher
* To be used within ALM Sports. (Fee's, Merchandise)

INSURANCE INFORMATION

Do you need ALM Sports Insurance? *

Yes, include ALM insurance

No, my child has insurance as primary

ALM insurance will be billed $1 per day

Primary Insurance Details
(your childs insurance carrier and policy number)

RULES OF THE AFTERSCHOOL PROGRAM

I have read and agree to the Program Rules *

Yes, I agree.

-Tuitition fees are due no later than Monday of the week your child is attending. If fees are not rendered it will result in your child's dismissal from the program.

- ALM Sports responsibilities end at 6:00 p.m. There will be a late fee of $10.00 for the first 10 minutes and every 10 min thereafter.

-If your child is still here after 6:30 p.m. and we have not been able to reach anyone at home, work, or at the emergency numbers, the Broward Police Department will be notified.

-As member of our program, children will be expected to respect the staff, each other, the facilities and the materials provided.

-If/when items are broken or taken, the parents of the child at fault will be responsible for replacing them.

-All Behavior incidents will be noted and an incident report form will be written up and parent will be notified. There will be a 3-Strike Rule on all behavior incidents.

- Major incidents involving behaviors that put the emotional and physical wellbeing of the other students and staff members will be subject to immediate termination from the program.

-It is the parents responsibility to notify ALM Sports if your child will NOT be attending after-school due to any family or medical reason. Please call 305-992-3799 or email jessika@almsports.com before 12pm (noon). If your child does not attend and you fail to notify us you may be subject to a small transportation fee in consideration of our staff's time and resources.

TERMS & CONDITIONS

I have read and agree to the Terms of Service *

Yes, I agree.

If your child is covered by a private insurance, you must provide us with proof of your child’s insurance coverage. If your child is not We offer this through WestPoint Insurers at a cost of $1.00 per day per sport. I give consent for my child to take part in the activity and consent to emergency treatment as necessary. I accept that the organizers and their employees are not under any liability whatsoever in respect of injury, loss or damage whilst on the course, other than imposed by law. I also allow ALM Sports to take photos for advertising and promoting purposes only; if you do not want your childs photo to be taken please email admin@almsports.com. I confirm that my personal insurance is correct and bears responsibility in case of accidents.
I confirm that I am legally entitled to give this consent and understand all payments received are non-refundable.