After School Care
at Premier Athletic Club
2016/2017 School Year Registration Form
Childs Name:
DOB:
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Age:
Grade:
Sex: M / F
School Child Attends:
Street Address:
City:
Mother's Name:_
E-mail
Street Address:
City:
Home Phone: (
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Work Phone: (
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Father's Name:_
E-mail
Street Address:
City:
Home Phone: (
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Work Phone: (
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State:
Zip:
State:
Zip:
Cell Phone: (
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State:
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Zip:
Cell Phone: (
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Registration Policies:
• All state required items (current emergency contact numbers, child health appraisal, permission for
transportation, and medical emergency forms), must be on file for enrollment.
• Please sign child out each day, and provide written notice of schedule change.
• Show respect to others and the facility, but most importantly, have fun! Staff will call parents for immediate
pick-up of child, if child exhibits disruptive behavior to either staff or other children, or exhibits any sign
of sickness.
• Accounts will be charged the 1st of each month.
• No refunds for absences!
• The schedule for all closings (vacations, holidays, snow days) follow the Hendrick Hudson School calendar.
• Cancellation of enrollment requires a 30 day written notice.
• Emergency drop-in care is available at a rate of $25.00 per day for members. $40.00 per day for non-members.
• Premier Athletic Club is not responsible for personal belongings.
I/ We understand and will abide by the registration policies.
Parent Signature:
Date:
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Transportation: Transportation from schools will be provided by the Hendrick Hudson Transportation Department
Schools Include:
Buchanan-Verplanck Elementary School,
Frank G. Lindsey Elementary School, and
Furnace Woods Elementary School.
*Permission for Transportation form must be sent to Hendrick Hudson Transportation Department
Kindergarten through age 12: Early Pick-Up (2:45pm-5pm)
Pricing for Members and Non-members:
•
5 Days a Week:
Afternoon Care: $200.00 per month (Member)
Afternoon Care: $270.00 per month (Non-Member)
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3 Days a Week:
Afternoon Care: $140.00 per month (Member)
Afternoon Care: $192.00 per month (Non-Member)
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2 Days a Week:
Afternoon Care: $105.00 per month (Member)
Afternoon Care: $152.00 per month (Non-Member)
Kindergarten through age 12: Late Pick-Up (2:45pm-6pm)
Pricing for Members and Non-members:
•
5 Days a Week:
Afternoon Care: $270.00 per month (Member)
Afternoon Care: $350.00 per month (Non-Member)
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3 Days a Week:
Afternoon Care: $192.00 per month (Member)
Afternoon Care: $240.00 per month (Non-Member)
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2 Days a Week:
Afternoon Care: $150.00 per month (Member)
Afternoon Care: $200.00 per month (Non-Member)
*A $10 late fee will be charged for every 15 minutes a child remains after their scheduled pick up time.
**Tuition fees are based on a 182-day school year divided into 10 monthly installments.
*Participants in the after school program will be allotted a spot into the Holiday Camp*
Discounts:
Sibling Discount is 10% off both siblings when enrolled for monthly billing.
Parent Signature:
Date:
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