After School Haven Registration

CHILD’S INFORMATION

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Gender
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Address
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PARENT’S / GUARDIAN INFORMATION

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PICK-UP AUTHORIZATION

Primary Pick-up contact details (Full name, relationship, phone NO & recent picture not more than 3 months old)
N.B : (In the event that the primary pick-up isn’t available, kindly notify the team not less than 24 hours. With a written authorization of whom will be doing the pick-up, with the recent photos attached)

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Recent Picture

MEDICALS

Does Your Child Have Any Medical Conditions / Allergies?
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PREFERRED PROGRAM PLAN

What’s your preferred option? 
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EMERGENCY CONTACT

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PHOTOGRAPHY and VIDEOGRAPHY

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RELEASE OF LIABILITY

The Program will take reasonable care in supervising children but will not be responsible for injuries or losses that occur without negligence on its part or due to circumstances beyond its control.
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CONSENT

I, [Parent/Guardian Name], hereby grant permission for my child, [Student Name], to participate in the [Name of After-School Program] program. I understand that the program will provide a safe and supervised environment for my child to engage in academic, recreational, and social activities. I confirm all information are accurate.
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SIGNATURE

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