Registration Form

  • *The FAMILY PASSWORD is used for the protection of your child.

    Circumstances may occur when you will need someone that is not listed on the registration form to take your child from this facility. When these circumstances arise, you will need to call and inform us of your instruction. You will be asked your password. Informing us of your password will enable us to carry out your instructions. If you do not provide or remember your password, we may not be able to carry out your instructions from over the telephone. The password for your child should not be given to any other individual. The password provides a code between staff and parents only to enable us to follow your instructions from over the phone.

    Step 1: Select Campus:

      Franklin Academy

  • Step 2: Child Information:

    *Gender:

    *Allergies/ Medical Concerns:

    *Is your Child currently in an ESE program or receiving any special services during the regular school day?

    *In the event of emergency, I can arrive at the facility within

  • Step 3: Parent/Guardian Information:

    Mother's Information:

    *Mother permitted to pick up child?

    Father's Information:

    *Father permitted to pick up child?

    *Is there anyone legally NOT allowed to pick up your child?

    Emergency Contacts

    Other persons authorized by the parent to pick up my child. If the parent cannot be reached, the following persons may be contacted in case of illness, injury, or emergency. It is the registering parents’ responsibility to keep this list current.

    (Must be 18 years of age and show picture I.D. to remove child from the center.)

    * Only allow a maximum of 6 Emergency Contacts.

  • Step 4: Influenza Virus & Distracted Adult Brochure

    Influenza Virus, The Flu, A guide to parents: During the 2009 legislative session, a new law was passed that requires child care facilities, family day care homes and large family child care homes provide parents with information detailing the causes, symptoms, and transmission of the influenza virus (the flu) every year during August and September. Distracted Adult is a brochure for all child care facilities parents/guardians with information pertaining to the dangers of leaving a child in a vehicle, including tips for prevention, during the months of April and September.

    *My signature below verifies that I reviewed the brochure on Influenza Virus, The Flu, A guide to Parents online at http://www.afterschool-connections.org/public/uploads/influenza_brochure.pdf

    *My signature below verifies that I reviewed the distracted adult brochure at http://www.afterschool-connections.org/public/uploads/distracted_adult_brochure.pdf

    Know your child care facility brochure

    *My signature below verifies that I reviewed the brochure on ‘Know Your Child Care Facility” online at http://www.afterschool-connections.org/public/uploads/know_your_cc_facility.pdf.

    Swim Central

    What It Is 954-357-SWIM (7946) • SWIMCentral@Broward.org

    SWIM Central is the coordinating agency for water-safety instruction and awareness in Broward County. It maintains the most comprehensive database in Florida for swimming pools and water-safety programs in the county. It is one of the only programs of its type in the country.

    (Signature required for Broward campuses only)

    *My signature below verifies that I reviewed more information on the ‘Swim Central” program online at http://www.broward.org/PARKS/PROGRAMSCLASSES/Pages/swimcentral.aspx

  • Step 5: Discipline Policy:

    The children are our first priority!

    The staff of After School Connections use behavior techniques that include positive reinforcement, redirection, conflict resolution and rewards. We expect all employees to treat the children in a respectful manner and for the children in turn to respond in the same way. We also expect the children to show this same respect to each other and to use all equipment and facilities in an appropriate manner.

    A child with a consistent behavioral problem who is not responding to his or her counselor or who exhibits extreme or dangerous behavior will be sent to the Site Director, who will notify the child’s parents and/or guardians with a Behavior Report. In extreme cases of behavior such as running away, fighting, extreme disruption, stealing, threats of violence, or destruction of school property, the parent and/or guardian may be called to pick up their child immediately and the child may be immediately suspended or dismissed from the after school program.

    If the problem persists, a parent/guardian conference will be scheduled at which the areas of concern and the steps which will be taken to help improve your child’s behavior will be discussed. If the situation does not improve, the child may be suspended.

    Discipline Policy and hours of operation:

    • Child (ren) shall not be subjected to discipline which is severe, humiliating, or frightening.
    • Discipline shall not be associated with food, rest or toileting.
    • Spanking or any other form of physical punishment is prohibited.

    Hours of Operation: School day dismissal - 6:00 pm including early release days (early release times varies campus to campus)

    I have read and fully understand After School Connections Discipline Policy. I acknowledge that I can access the Parent Handbook through the website at www.afterschool-connections.org

  • Step 6: Student Discipline Policy:

    In After School Connections we feel strongly that a positive, supportive and structured environment promotes good behavior. A full day of varied activities is planned to direct your child’s energy into positive channels. We believe that children learn from us and that we are their positive role models.

    Our counselors and Site Directors/managers have a goal to help children feel good about themselves by building their self-esteem and self-confidence. Whenever discipline is necessary, corrective discipline is used to change the inappropriate behavior of the child, never to hurt the child.

    The following are the steps taken to correct inappropriate behavior in our program and to insure the safety and wellbeing of all our children:

    • Counselors will first take your child aside and quietly speak to him/her about their behavioral concern. If the inappropriate behavior warrants, the counselor will either put the child in thinking time (appropriate to their age) or if necessary have the on-site manager speak to the child. The child will receive a verbal warning.
    • A child’s second serious behavior incident will result in a phone call to the parents as well as a written behavior report.
    • A child’s third behavior incident will result in a phone call to the parent from the Site-Manager and possible suspension or expulsion from the program.

    Student Behavior Contract

    1. I will not hit, kick or hurts others.

    2. I will listen to my counselor.

    3. I will follow directions.

    4. I will not say mean things to anyone.

    5. I will stay with my group.

    (Parent and child must initial each item)

  • Step 7: Consent Form:

    I hereby give my consent to have my child participate in all activities in the after school program. I also realize that After School Connections will not be responsible for any minor injuries that might occur during the normal school day (ex. Scratched knee, cuts, bruises, bites, etc.) I have read the above and hereby give my consent.

    Nutrition Plan Agreement

    Indicate special Dietary Requirements:

    I understand and approve the use of the Alternate Nutrition Plan. I agree to provide the snack from home to meet my child’s nutritional and dietary needs.

    Video/ Photo Release

    I give permission to After School Connections or any school approved agent to photograph/video my child for the purpose of promoting the after school program or demonstrating the program’s accomplishments and activities. Photos may be published on brochures, the aftercare school website, flyers, advertisements, etc.

    Authorization for Emergency Medical Treatment

    In case of any emergency, After School Connections will attempt to reach either parent or the emergency number given by the parent. If for any reason none of these parties are available, I authorize After School Connections to use and transport to the closest medical facility and grant permission to perform any emergency procedure at the discretion of that medical facility.

    First number to call when a parent cannot be reached!

  • Step 8: Payment Policy:

    REGULAR PROGRAM FEE: $193.00 per 4 week period and a non-refundable registration fee of $45.00 per family. $174 per 4 week period for any additional sibling.

    Tuition is due a week before the new session begins, Monday through Thursday. Please make checks payable to After School Connections. You can also submit a payment online. Tuition paid for the entire school year will receive session 10 for free.

    PAYMENT POLICY & PROCEDURES: Payments must be made prior to the start of the attendance period. There is a no refund policy. No refunds will be issued unless a child is dismissed for disciplinary reasons from the program or if he/she is withdrawn from the school. If your payment is late, a $25 late fee will be charged. The late payment fee must be paid no later than the first week of the new session.

    **** Effective May 1st through end of school year, we will no longer accept payments in the form of a CHECK. This includes but is not limited to: tuition, late payments and late pick up fees. We will only accept money order, cashier check or online payments. Please visit our website at www.afterschool-connections.org to make an online payment.

    These fees are based on an annual tuition of services provided and are divided into equal payment periods for your convenience.

    RETURNED CHECK CHARGE: If you choose to make payments via check and there is a returned check, a charge of $25 will be made and all subsequent payments must be through money order or credit card for a period of one year.

    LATE PICK-UP CHARGE: The late pick up fee is $1.00 per minute after 6:00 p.m. This fee is due by check or credit card upon picking up your child. After 3 late pick-ups in the same 4 week session, we reserve the right to drop your child from our enrollment.

    I acknowledge the payment schedule of fees (which is available on the website under the make a payment tab) and it will be paid by me for my child’s attendance at After School Connections program. I understand that in the event I fail to pay these charges in a timely fashion and collection procedures are started or suit is initiated to collect unpaid charges, I will be responsible for all collection costs, 18% interest on the unpaid charges and reasonable attorney’s fee for counsel to After School Connections.