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Agile Learning Center

Independence x Intentionality

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After School Registration & Contact

Register for After School or send a message to the program coordinator below

Parent Name *
Parent Email *
Please select what you would like to do
Your message to the ALC After School program coordinator:
Participating child’s name *
age *
pronouns

You may only register one child at a time. If you are registering siblings, please complete this form for each child.

Contact information

Parent/ Guardian – primary contact
name
*
email *
phone *
Parent / Guardian 2 –
name

email

phone number
Parent / Guardian 3 –
name

email

phone number

health & emergency information

Emergency Contact (Name, Relationship, and Phone Number): *
Does your child have any allergies, medical conditions, or other health information we should be aware of? *
Additional health information *
If your child is seriously ill or injured and none of your emergency contacts can be reached, please tell us your preferences for emergency care: *

dismissal & outings permissions

How should we dismiss your student at the end of the program? *
Adults authorized to pick up my child:
Any additional dismissal instructions
(for example: may leave on their own after 5pm; may leave with a peer at 5:30pm, etc.)
I give my child permission to leave school premises: *
Minimum age of accompanying student *
Please describe any other requirements you have for the above permissions to be granted
Parent/Guardian full name *
Today’s date *

Class registration

Select the classes you would like to register for *
WHICH RATE APPLIES TO YOUR REGISTRATION? *
*The reduced rate applies to current ALC families and to all children when two or more siblings are registering for after school during the same school term. Please submit a separate registration form for each child, marking “siblings rate” on all registrations within the same family.
Registration Total
$
0.00
How would you like to pay? *
Full Payment
Amount due upon receipt of invoice
$
0.00
Three-installment schedule
Payment 1 – due upon receipt of invoice
$
0.00
Payment 2 – Due November 1
$
0.00
Payment 3 — due December 15
$
0.00

Registration Agreement

The following highlights several important terms of registration. Please review the full After-School Program Policies & Agreements before submitting your registration.

Registration is for the semester. You may cancel for a full refund before the semester begins or withdraw after either of the first two classes and pay only for classes attended. After the first two classes, tuition is nonrefundable.

There are no refunds or credits for individual absences. If ALC cancels a session, you will receive a prorated refund or credit.

After School ends at 5:20 pm, and students must be picked up or dismissed by that time.