Graffiti Church Children's After School Program Fall 2026

Parent / Guardian Information

Parent/Guardian Name

Phone Number

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Address

Child's Name

Date of Birth

Gender

Male
Female

Current Grade

Child's School

Child's Teacher

Does your child have a special needs IEP/504 plan?

If yes, please upload your child's paperwork here.

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Does this child have any prescribed medications

Does this child have any allergies

Please list any Limitations which may affect your child’s activities: (If none, then write none.)

Please Select Your Registration *

Fall Semester- Single Child Fee
$300.00 ea.
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Half Price Sibling Fee
$150.00 ea.
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Emergency Contact Name

Emergency Contact Phone

We allow up to 6 adults (over 18 years old) to be listed as authorized to pick up your child/children from our After School Program. Please indicate below if you need to add persons, and continue to do so for up to 6 people.

Add Adult #1

Is there someone who does NOT have permission to pick up your child? If so, please provide their name.

Cancellation and Policy Agreement

We are excited your child will be joining us for the Graffiti Kids After School Program. Guardians will need to fill out our Release of Liability form. The form can be obtained in person at Graffiti, can be printed and brought with your child on the first day of program, or emailed to [email protected]. We have also included our Cancellation Policy and Online Agreement Consent. If you have any questions or concerns, please contact us before finishing your application.

I understand that Graffiti Community Ministries, Inc. is a Christian organization; therefore Christian values will be taught and upheld as part of daily activities*

TUITION: I understand that there is a NON-REFUNDABLE $50 application fee for registration and the remaining balance of $250 (for a Total of $300 for each semester). This application ensures the registration and enrollment for Semester 1 (Sept. 23, 2024 - December, 2024). Payment for the fall semester is due by September 23, 2024.*

LATE PICKUP: I understand if I am late picking up my child from After school, then I am required to pay an additional $5.00 for every 5 minutes after 6 pm. The late fee must be paid Within 2 program days after the late pickup date in order for my child to continue attending the program.*

BEHAVIOR: I understand that safe and acceptable behavior is a condition of my child’s enrollment in Graffiti After School. I understand my child must follow the rules, policies, and procedures outlined in the Parent Orientation Packet. Unacceptable behavior will be corrected verbally, with time-out breaks, with meetings with parent/guardian, and lastly through suspension/expulsion from Graffiti After School with no refund eligibility.*

ORIENTATION: I will attend a Virtual parent orientation (DAte: which is TBA) I understand that if I dont attend, I am still responsible for reading and abiding by the policies outlined in the PARENT HANDBOOK provided to me. I will be required to sign and return a form confirming my compliance.*

At this orientation, we will be reviewing the Parent Handbook provided and available to all parent upon arrival on the first day of program. we will discuss plans for the fall, distribute Callender with dates for the current module. answer any question or concerns you may have, greet and meet with our director and leaders who will be participating with your child's curriculum while with in our program. Note that in Graffiti your children are and will always be our priority

Terms and Agreement

I have read and agreed to the terms above and I understand there are no refunds after submitting payment for Graffiti Kids After School Program. By signing this form I acknowledge that the policies above apply to every child I enroll.

I, the undersigned, agree to the terms above.

Total

$0.00

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Graffiti Church After School Program Fall 2026

Parent / Guardian Information

Please Select Your Registration *

Cancellation and Policy Agreement

Billing Information