Before and After School Care Registration 

Student Information
Emergency Contact Information
The first attempt will be made to contact parents/guardians. Emergency Contacts listed below must be able to pick your child up in the event of an emergency.
Terms and Conditions of Enrollment
  1. No student will be properly enrolled in Symone Center for The Arts Program without the following paperwork completed and up to date: registration fee, participant application, payment, medical form, emergency form, and other required documents if your child has allergies, asthma or requires medication.

  2. No refunds will be granted if the participant leaves the program, on his/her own account or is removed from the program due to an inability to adjust or is unable to function adequately or to comply with the program rules. There is no reduction or refunds based on missed days due to absence, illness or early withdrawal. All payments are due on the first of the billing month. Additionally, a one month deposit is due on the first day.

  3. For safety reasons, we must know, in advance, which children are expected to attend on any given day. Daily fees are paid at the end of the week once services are rendered.

  4. If there is any change in your request for days, you must notify the extended care coordinator. No refunds will be given for absences due to illness or vacation. You have the option to register for Early Release/Full Days. 

  5. All late payments are subject to a $40.00 weekly late fee.

  6. Pick up is at 6:00 PM any child not picked up by 6:00 PM, the responsible party will be charged a $1.00 per minute additional fee for late pickup.

  7. A Registration Fee of $50.00 per participant is required for the extended care program.

  8. I am aware that my student must follow the rules and regulations of the program and may be terminated from Symone Center for The Arts program if he or she does not comply.

  9. I hereby consent to the taking of photographs, movies, Internet use, and videotapes, of my child Symone Center or its designated representatives. I also grant the right to edit, use, and re-use said products for any and all educational or public service I release any and all rights, title, and interest we or the child may have in said products. Photocopies and facsimiles of this Release and consent shall have the same legal effect as the original (Please indicate your permission below).

10. Symone Center for The Arts Summer Program is not responsible for any personal items that are lost stolen          or damaged while attending.

11. I consent that in an emergency Symone Center for The Arts may obtain medical treatment if necessary. I             understand that if medical treatment is deemed necessary I will be informed as soon as possible.

12. I reviewed the application and all the information provided is accurate and true. I agree to all the terms and         conditions.

13. I have received a copy of “A Parent’s Guide to Regulated Child Care.”

Health Information 
List any specific medical conditions or behavioral problems? Does your child have any other allergies (food, hay fever, etc)?
Are there any activities in which your child may not participate?
Are there conditions or specific needs that require special attention?
Will your child be taking medication during operational hours?

Please pack all medication in a sealed container, clearly labeled with your child’s name, age, medication, dosage and time and deliver to your child’s teacher for the week.

The information listed on this health information form is correct to the best of my knowledge, and the participant described herein has permission to engage in all prescribed program activities, except as noted on this form.


as parent/guardian, authorize Symone.

Center for The Arts personnel to seek emergency treatment as required and to transport my child to the appropriate medical facility in the event that urgent/emergency care is necessary.

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