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After School Program Registration Form

- Parents

2024-25 Registration Form
The maximum number of form submissions has been reached. This form is currently not available.
- Please list name (first and last) and 2024-25 grade for each student enrolling the after school program. REQUIRED Please fill out this field.
- Please list days of planned attendance. REQUIRED Please fill out this field.
- Registration Fee: A non-refundable annual fee of $50 per family. The registration fee will be billed through FACTS.
  
  Rate: $9.50 per hour, per child to be billed monthly through FACTS.
  
  Late Pick-Up Fee: All students are to be picked up by 6:00 pm or 3:00 pm on early closure days (refer to school calendar for specific dates). Students who are not picked up by 6:00 pm (or 3:00 pm on early closure days) will incur an additional charge of $3 per minute.
- Authorized Pickup: Parents must be listed along with an alternate.
  The following contacts listed below may serve as my agent and have my permission to pick up my student from the St. Mark Catholic School After School Program and receive information distributed by the staff.
- PARENT 1 - First and Last Name REQUIRED Please fill out this field. Please enter valid data.
- PARENT 1 - Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
- PARENT 1 - Email Address REQUIRED Please fill out this field. Please enter valid data.
- PARENT 1 - Address REQUIRED Please fill out this field. Please enter valid data.
- PARENT 1 - Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- PARENT 1 - Driver's License Number and Issuing State REQUIRED Please fill out this field. Please enter valid data.
- PARENT 2 - First and Last Name REQUIRED Please fill out this field. Please enter valid data.
- PARENT 2 - Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
- PARENT 2 - Email Address REQUIRED Please fill out this field. Please enter valid data.
- PARENT 2 - Address REQUIRED Please fill out this field. Please enter valid data.
- PARENT 2 - Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- PARENT 2 - Driver's License Number and Issuing State REQUIRED Please fill out this field. Please enter valid data.
- ALTERNATE - First and Last Name Please enter valid data.
- ALTERNATE - Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
- ALTERNATE - Email Address REQUIRED Please fill out this field. Please enter valid data.
- ALTERNATE - Address REQUIRED Please fill out this field. Please enter valid data.
- ALTERNATE - Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- ALTERNATE - Driver's License Number and Issuing State REQUIRED Please fill out this field. Please enter valid data.
- I have read the St. Mark Catholic School After School Program Handbook and agree to follow the policies and procedures as stated.
  I Agree Please select this field.
- Parent Signature REQUIRED Please fill out this field. Please enter valid data.
Submit

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