Child's Name *

First Name

Last Name

1. Parent/Guardian *

First Name

Last Name

Primary Phone Number *

(###)

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Days Requesting After School Services *

Monday

Tuesday

Wednesday

Thursday

Friday

Please Pick One *

I would like Learning Lab to pick up my child at PS 144 (add'l $3 per day)

My child will be dropped off at Learning Lab

Deposit *

Your child's spot will be reserved for the upcoming school year when a deposit is received. A nonrefundable deposit of $150 per day based on the number of days your child will attend in a week. For example, if you would like to register your child for Mondays and Tuesdays, your deposit will be $300 or if you register your child for all five days, your deposit will be $750. The deposit will be applied to your invoice for the first semester. An invoice for the deposit will be sent to you after the after school registration form is completed.

I understand a deposit is required to reserve a spot for my child in the program.

Cancellations of Services *

For the safety and welfare of all children attending programs at Learning Lab, we retain the right to terminate services for the following reasons: • The child’s behavior is destructive, uncontrollable, or threatening or violent to other children or staff members. • A parent/guardian refuses to pay tuition.

I Agree