Editing previous response:

Please fix the highlighted areas below before submitting.

5th Grade Band After School Application

Please complete the form below. Required fields marked with an asterisk *

Description:

As the first cycle of after school band comes to an end we look forward to the beginning of the 2nd cycle. The 2nd cycle will start on Thursday March 5, 2020 and will end on Thursday May 28, 2020. We have new music to work on and have made great strides in the first cycle. We would like to build on our successes in the 2nd cycle. The cost of the program is $100. Please make payments through school website. We look forward to having a productive 2nd cycle. Please join the remind group below for after school

Cost:

The cost for a single child is $100.

Important Notes:

*Please send your child with a healthy snack and a water bottle

Please fill out the below if you would like to register:

Student Information

Child's (Children) First Name *

Answer Required

Child's (Children) Last Name *

Answer Required

Grade/Class *

Answer Required

shirt size *

Answer Required

Parent/Guardian Information

Name of Parent/Guardian *

Answer Required

Phone #1*

Number Required

Phone #2

Number Required

Email*

Answer Required

Medical Alerts

Does your child (children) have allergies? (Please list):*

Answer Required

If so, does your child require an EpiPen?*

Answer Required

Yes

Does your child (children) have asthma or any other medical conditions that would impair their abilities to engage in any physical activities? Please indicate:*

Answer Required

Dismissal Authorization

My child is authorized to be released to the following individuals (3-6 persons). Please put their first and last name:*

Answer Required

Please read and check off that you acknowledge and agree to the policies/conditions outlined below.

Public School 29 After School programs follow the NYC Department of Education Code of Discipline, which subjects all students to possible suspension or expulsion from the program contingent on their infractions. Parents are responsible to review the NYC Discipline Code with their child.*

Answer Required

Yes, I acknowledge and agree to the policy regarding the NYC Discipline Code.

Parents/Guardians are responsible to have their child picked up no later than the program’s end time. A late sign out book will be placed at the security desk and parent/guardian will be required to sign every day. If a parent/guardian is late 3 times, the child will be removed from the program.*

Answer Required

Yes, I acknowledge and agree to the policy about late pick-up.

Please type your name (signature):*

Answer Required

Check Box:*

Answer Required

I understand that by checking this box, I am confirming my electronic signature, email, and acknowledgement of all information and permissions provided on this form.

Payment:

Please click here to make the payment for 5th Grade Band

Make sure you return back to this window to sumbit your application.