Registration - After School Program

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Child's Name *

Grade

Date of Birth *

Parent / Guardian #1

Parent / Guardian #2

Siblings

Add sibling names & ages, each on a new line.

Address

City

Phone (note: this number will be used for logistical and transport needs of your child) *

Zip

Secondary Phone (please give a different number in case we can't reach you on the primary number)

Email *

Other

Emergency / Medical Information

Emergency Contact *

Emergency Phone *

Doctor's Name *

Doctor's Phone *

Doctor's Address

Doctor's City

Doctor's Zip

Medical / Physical Conditions

Please add any important information about your child, such as medical or physical conditions (e.g., asthma) above.

School & Transportation

School Name

School Address

School City

School Zip

Class

Teacher

Dismissal Time

Transportation Option *

1. Designated Greeter(s) receives and initials for child at your home. Please notify us of no more than three (3) selected individuals and their relation to the child.
2. Doorman receives and initials for child. If you choose this option, we will need to verify that someone is home to receive the child. Doormen are typically not responsible for children when there is no one home unless expressly per parental permission. Please speak to doormen about giving permission to sign for child.
3. Buzzer Entrance. We will make sure that the child safely enters your home and the door closes behind them before we leave (only option that does not require receiver).
4. Non Transportation Program

IMPORTANT
The designated caretaker receiving the child will be required to initial our drop off sheet. Whether it be a parent, grandparent, nanny, babysitter, or doorman, EVERYONE must follow this procedure.

Greeter #1

Relationship

Greeter #2

Relationship

Greeter #3

Relationship

Dooman #1

Doorman #2

Doorman #3

Program Selection

Corbin's Gear

Purchase is optional

Lacrosse Gear:

For Boys: Helmet, gloves, stick, shoulder pads and arm pads required for program
For Girls - stick, goggles and mouthpiece required for program

Lacrose

Helmet
Stick
Goggles

Ice Skates Rental

1 Season - $150

Coupon Code

Custom Total ($)

Total: 0.00

Cancellation Policy and Deposit Schedule:
A non-refundable 20% deposit is due with the application in order to secure a spot. Payment in full is due one month prior to start of program, 50% of which is refundable upon cancellation. After the first day of the program all fees are non-refundable.