Enrichment Clubs Registration Form

Please fill out an application for each child. Following this form you will select the enrichment club for this child and make payment in full for the semester.  If you would like to make alternate payment plans print and fill out the forms offline.
Childs Name *
Childs Name
Parent's/Gaurdian's Name *
Parent's/Gaurdian's Name
Address
Address
Phone #1 *
Phone #1
Phone #2
Phone #2
Emergency Contact
Emergency Contact *
Emergency Contact
Other than parent
Emergency Phone *
Emergency Phone
Alternative Pick Up
Alternative Adult Pick Up
Alternative Adult Pick Up
(other than parent)
Phone
Phone
Waiver Statement (Required for participation) *
In the event of an emergency involving my child, and if Preferred School Care is unable to contact me, I hereby authorize any needed medical care. I further agree to be fully responsible for all medical expenses incurred during the treatment of my child. I will not hold Preferred School Care, its agents, instructors, volunteers, or partners liable.