Landmark Beyond the Bell (BTB) Afterschool Registration

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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.
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.