Northern's STARS Program
After School Program
A school registration form must be completed prior to registration for the Northern STARS Program. Priority to admittance will be given on a first come first serve basis. You may be put on a waiting list, depending on the number of children currently enrolled in the program.
Registration and Tuition Agreement:
I understand a non-refundable $25.00 registration fee is due upon registering for Northern STARS Program. I also understand each month's tuition as outlined in the handbook is due on the first school day of each month. I agree to make payments on time and if I am late, I will be subject to a late fee(s) and risk my child being removed from the program. Plus by signing below I agree that my child can watch any G or PG movie shown by Northern’s STARS Program. Finally, I understand by signing below I have read, understand and agree to all terms in the Northern’s STARS program handbook.
Medical Emergency Transportation
I give permission to Northern Elementary School to transport my child to Georgetown Community Hospital in case of a medical emergency which will require professional medical attention. This decision can and will be made at the discretion of the Northern Elementary principal, staff and/or Northern STARS Program staff.
Child’s Name __________________________________________
Date of Birth ___________________________________________
Parent/Guardian’s Name (please print) ______________________
Parent/Guardian’s Signature ______________________________
Phone Number ________________________________________
Email Address _____________________@__________._______
Primary Physician Name ________________________________
Primary Physician Number_______________________________
This form must be completed at time of registration.
You must allow 24 hours before your child can attend.
Office Use Only:
Registration Payment Method ________ Check Number _________
Date_________ Grade _________ Homeroom Teacher _______________
Snow Day Release ___________