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:

    * Registrations are closed at this moment. For more information, please contact your campus manager.

  • Step 2: Child Information:


    *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 seasonal information on Influenza Virus, The Flu resource center online at

    Know your child care facility brochure

    *My signature below verifies that I reviewed the brochure on ‘Know Your Child Care Facility” online available at

    Swim Central

    What It Is 954-357-SWIM (7946) •

    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

  • 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 time to 6:00 pm and early release days from 12:00 pm – 6:00 pm

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

    We reserve the right to dismiss your child from our program in the event that a parent does not comply with our policies and/or displays inappropriate behavior towards employees or staff.

  • 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)

    understand that my child will be expected to behave in accordance with the code of conduct. Disruptive behavior or actions posing a threat or any danger to them or anyone else will result in dismissal.

  • 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 injuries that might occur during the normal school day and After Care hours. 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: $50.00 non-refundable Registration fee per family per school year. $210 tuition fee per 4-week period for first child and $189 per 4-week period for any additional sibling.

    School Faculty/Employee Fee: $50 non-refundable Registration fee per family per school year and a $60 tuition fee per 4 week period per child.

    Early Care is only offered at our Pines K-12 campus for $50 per 4 week period and $45 per 4 week period for any additional siblings. For both early & afternoon care will be $247 per 4-week period and for any additional siblings both services are $223.

    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.

    PAYMENT POLICY & PROCEDURES: Payments must be made prior to the start of the attendance period. If payment is not received by the due date provided, your child will be considered unenrolled from our program. There is a stringent no refund/ no credit policy. Including but not limited to, unexpected school closures, inclement weather/hurricanes, pandemics, child sickness, withdrawn/dismissed from the program and or 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.

    ****May 1st (of each year) through end of the school year, we will not 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 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, PER CHILD 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. 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.

  • Step 9: COVID-19 Liability Waiver

    I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that After School Connections LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I acknowledge that After School Connections LLC has a stringent no refund/no credit policy. In the event there is a Covid-19 case, I acknowledge that After School Connections will be required to close as a safety measure.

    I further acknowledge that After School Connections LLC cannot guarantee that my child/ren will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, aftercare staff, and other aftercare participants and their families.

    I voluntarily seek services provided by After School Connections LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I and my child/ren must comply with all set procedures to reduce the spread while attending After School Connections aftercare program.

    I attest that:

    • I nor my child/ren are not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
    • I nor my child/ren have not traveled internationally within the last 14 days.
    • I nor my child/ren have not traveled to a highly impacted area within the United States of America in the last 14 days.
    • I nor my child/ren do not believe have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
    • I nor my child/ren have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities.
    • I and my child/ren am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

    I hereby release and agree to hold After School Connections LLC harmless from, and waive on behalf of myself, my child/ren, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself, my child/ren and/or property that may be caused by any act, or failure to act of the aftercare program, or that may otherwise arise in any way in connection with any services received from After School Connections LLC. I understand that this release discharges After School Connections LLC from any liability or claim that I, my child/ren, my heirs, or any personal representatives may have against the aftercare program with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from After School Connections LLC. This liability waiver and release extends to the aftercare program together with all owners, partners, and employees.