Birdsong Beyond the Bell (BTB) Afterschool Registration

This field is hidden when viewing the form

Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.
MM slash DD slash YYYY
Referred by(Required)
Student's Name(Required)
Parent / Guardian's Name(Required)
Relationship to Student(Required)

MM slash DD slash YYYY
Address(Required)
Grade Level(Required)
My student receives I.E.P/504 accommodations: If you check yes we will set up a meeting to review accommodations to ensure we are able to serve your student appropriately.(Required)
ForKids staff have permission to contact my student via phone call, text or email regarding program and/or school activities/assignments.(Required)
COVID/Health protocols- Read and acknowledge agreement to the following:(Required)
Students who are/become symptomatic at program and a parent/guardian is unable to pick up early will be required to wear a face mask until departure and must be symptom free to return. Students must stay home if they are symptomatic Students must be symptom free for 24 hours without medication before returning to program Any child who is identified with COVID 19 will be required to withdraw for 5 days. Any child who is exposed to positive COVID case will be required to share a negative COVID test before return and mask for three days.
As legal guardian or parent, I authorize any emergency medical treatment deemed necessary, or advised by a physician or dentist for my child.(Required)
Program Rules & Expectations: Students are expected to behave as responsible citizens including good attendance ; good attitude -engaged and ready to participate, and respect for themselves, others, staff and volunteers. I have read the program rules and expectations and discussed them with my student.(Required)
I understand my student may be photographed and/or videotaped while participating in the program. I hereby give permission for ForKids, news media, and any other third party organizations to use any photographs or videos for any promotional purposes.(Required)
ForKids Beyond the Bell program aims to provide support to families in need. Please check all that apply:(Required)