ASPIRE 2024-2025 Registration

ASPIRE Sign Up

Child's Information

Child's Full Name(Required)

First Last

Date of Birth(Required)

Age(Required)

Grade(Required)

Gender(Required)

Parent/Legal Guardian Information

Parent/Legal Guardian Information(Required)

First Last

Date of Birth(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

(2) Parent/Legal Guardian Information

First Last

Date of Birth

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Medical Information

Primary Doctor's Name(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Medical Insurance Provider(Required)

Policy Number(Required)

Does your child have any allergies to food, medications, or any other substances? What are the symptoms and what action needs to be taken if any?

Does your child have a time-sensitive medication that needs to be administered between 3-6pm? If so, what medication and what dosage? (We would prefer to not have to administer medication, however, we understand that it might be necessary.)

Emergency Contact Information (Someone who is NOT you and NOT your advocate):

Name(Required)

First Last

Relationship to Child(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Additional Information

Authorized Person for Pick-up; as listed on ID(Required)

Relationship to Child(Required)

Person NOT Authorized for Pick-up(Required)

Relationship to Child(Required)

Primary of of Transportation(Required)

Bus

Walk

Pick up/Drop off

School Name(Required)

Office Number(Required)

Bus Number

Attendance Policy

To ensure that we have enough staff, food, and equipment for each activity and group, ATTENDANCE IS KEY! Please notify us within 24 hours whether your child(ren) will not be attending the program for the following day. For an excused absence, you will have an additional 24 hours to let us know why the youth missed the day (doctor’s appointment, sick, vacation, etc.). Please contact a youth advocate through email or call the receptionist at (952)-884-0376. If a child has numerous repeated absences without notification, we will schedule a parent meeting to discuss alternative options that best meet the child and family needs. ASPIRE programming ends at 6pm. There will be a 15-minute buffer period for pick-up, meaning that ALL youth MUST be picked up by 6:15pm! If a family strays from this schedule, we have the right to un-enroll the youth from our programming. If there is an emergency that comes up, we will be understanding and flexible as long as it doesn’t become a habit.

I have carefully read this waiver and release. I understand and voluntarily agree to be bound by the provisions of this waiver and release.

Name(Required)

First Last

Date(Required)