After-School Registration Page After-School Sign up If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. By filling up the form below, the space for your child/children will by reserved for the After-School Program with CapoKids. Child's Last Name * Child's First Name * Age * Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code * Email * Phone * Alt Phone Parent/Guardian First Name * Parent/Guardian Last Name * Please list any allergies your child may have: Further Comments Choose Location Below Select Location * SRQ (MacIntosh)LWRPHS (Proctor) Select School: * South Side ElementaryPhillip Shore ElementaryAshton ElementaryBrentwood ElementaryWillis ElementaryBranden River ElementaryMcneal ElementaryPinnacle ElementaryGullet ElementaryLakeview ElementaryFruitville ElementaryTatum Ridge ElementaryGulfgate Elementary I understand that the above prices will be paid rather or not my child/children attend the classes. I understand that all changes and/or cancellations need to be in writing in one of our offices and they will not be accepted by phone or email. * I understand that I must pay the weekly dues in the beginning of the week. The total price of our After-School Program is divided in 43 payments throughout the school year. That makes our program more affordable but you will be paying for holidays and vacations as well. The first payment will begin the date your child starts school. All payments will be paid in full the first day of the week with my credit card on file. I understand that my account must be paid in full even if my child does not attend all the days. In early release days, you will be charged $10.00 extra per day for children in Lakewood Ranch only if your child is picked up earlier on those days. In Day Camps you will be charged only $20.00 for the full day of camp (field trips not included). You understand that your account will be charged a fee of $1 per minute for pick up after 6pm. The money will be paid to the person watching your child. I (Include Full Name) have read the above payment contract and agree to all of the terms.