RISE After School Program
301 Eva Davis Way
Atlanta, GA, 30317

Enrollment

My child... *

is a current Drew Charter School student.

will be enrolling as a new student for the upcoming school year.

Villages Of East Lake Status

Villages of East Lake Resident? *

Yes - I am a Villages of East Lake resident

No - I am not a Villages of East Lake resident

Participant Information 1

First Name *

Last Name *

Birth Date * +

2019-2020 Grade Level * 🛈

Gender *

Race/Ethnicity *

T-Shirt Size *

Medications/Allergies *

0/255 characters

Participant Information 2

First Name

Last Name

Birth Date +

2019-2020 Grade Level 🛈

Gender

Race/Ethnicity

T-Shirt Size

Medications/Allergies

0/255 characters

Participant Information 3

First Name

Last Name

Birth Date +

2019-2020 Grade Level 🛈

Gender

Race/Ethnicity

T-Shirt Size

Medications/Allergies

0/255 characters

Participant Information 4

First Name

Last Name

Birth Date +

2019-2020 Grade Level 🛈

Gender

Race/Ethnicity

T-Shirt Size

Medications/Allergies

0/255 characters

Household / Adult Primary Contact

Relationship to Participant: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Alternate Phone

Email Address *

Additional Parent/Guardian Contact

Relationship to Participant:

First Name

Last Name

Address 1

Address 2

City

State

Zip

Phone

Alternate Phone

Email Address

Authorized Pick-Up List

First Name *

Last Name *

Phone *

Alternate Phone *

First Name

Last Name

Phone

Alternate Phone

First Name

Last Name

Phone

Alternate Phone

First Name

Last Name

Phone

Alternate Phone

Acknowledgements

I understand that the program ends at 6:00PM. I understand that beginning at 6:15 I will be charged a late fee of $1.00 per minute. I understand that multiple late pickups can lead to removal from the program. I understand that I cannot allow my child to sign themselves out and wait for me outside. Any child caught doing so can be removed from the program. I understand that my child must be signed out of the program every day and the person picking them up must be on the authorized list. I understand that electronic billing statements are provided monthly via Kinderlime. I understand that if I decide to remove my child from the program, I must do so in writing. If not, I will continue to be charged the weekly rate which I will be responsible to pay. I understand that the same rules for behavior that are set during the school day apply for after school as well. If my child is consistently disrespectful, rude, or violent they can and will be removed from the program. I understand that the RISE After School Program is not responsible for any lost, stolen or damaged property. I will instruct my child to leave all valuables at home or properly monitor and care for those items in their possession during the program. I understand that my balance must be clear and my registration fee paid in order to be officially registered for the program. I understand that program admission is on a first come, first served basis. I understand that my acceptance is based on availability. *

Yes

No

Signature

By signing below, I agree to the terms of this program as outlined above, including payment of all fees and costs associated with the program. I also certify the above information is correct to the best of my knowledge.

*

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