Club Impact: Registration


Both ParentsFatherMotherGuardian
YesNo
Part-time/Drop-in: $5.50 per hour, per childAM &/or PM- $65 a weekNone of these

Drop-in 1/2 Day: $26 per day, per child (6 hours or less) - No field trip/Meal Options Available on this option

Drop-in Full Day: $36 per day, per child (Field trip/Meal options available)-Please ask Mrs. Liz for details.

Full-time (If registered before May 1st): $150 per week, per child (Includes ALL Field Trips & Meal Vouchers)

Full-time (If registered after May 1st): $160 per week, per child (Includes ALL Field Trips & Meal Vouchers)"

Drop-in 1/2 DayDrop-in Full DayFull-time (registering before May 1st)Full-time (registering after May 1st)None of these

It is the parent’s/guardian’s sole responsibility to provide all necessary information on this form. It is also the sponsor’s responsibility to assign, delete, and maintain only those names which are listed on this form. Any changes made on this form can only be made by the sponsor. Any changes must be submitted in writing to the program director.

Please note that your child will only be released to those people listed on your authorization list. Please BE PREPARED to present a valid picture ID at time of pick-up.