2021-22 Newark Center In-person Afterschool Registration (TK-6)Monday-Friday, 3:00pm - 6:30pm (Grade 1-6), or 12:00pm-6:30pm (Grade TK-K). We will be closed on Federal holidays.Please enable JavaScript in your browser to complete this form.Student Name *FirstLastStudent Date of Birth *mm/dd/yyyyStudent Grade in September 2021 *Grade TKGrade KGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Student's Allergy Information Student Name (Sibling)FirstLastStudent Date of Birth (Sibling)mm/dd/yyyyStudent Grade in September 2021 (Sibling)Grade TKGrade KGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Student's Allergy Information (Sibling)Disclosure of Existing Medical Condition(s)If student or sibling has any existing medical condition(s), then please disclose the information to Golden Bear Education.Name of Student's Elementary School *If children from the same family are attending different schools, then please type children's names following by the school names they are attending.Program SelectionRegular Afterschool (3:00pm-6:30pm, $480/month)Extended Afterschool (12:00pm-6:30pm, $590/month)PickupSelf-Pickup (Parents pick-up and drop-off)Need Pickup Arrangement (Golden Bear will refer pickup driver. Pickup fee is $120-$150 per month.)Driver Pickup fee is between $120 and $150 per month depend by school distance and driver. Schools within 1 mile might have a special discount.Start Date (1st Day to Attend Afterschool)mm/dd/yyyyTuition and Fee DetailsRegular Afterschool (3:00pm-6:30pm), $480/monthExtended Afterschool (12:00pm-6:30pm), $590/monthRegistration Fee ($70/school year)Material Fee ($150/school year)Pickup Fee (starting at $120 per month, may vary based on school distance)The tuition for August, December, and June may be different among different school districts due to school schedule difference. Please refer to the invoice for those months for details. Sibling tuition discount is 10% off. Sibling discount does NOT apply to registration fee, material fee, and pickup fee.New Student Referral DiscountOne-Time $50 invoice credit for both familiesThe one-time $50 referral invoice credit will be applied to the second month's invoice for both families after the referred family successfully stayed for one month and decide to continue the program.New Student Referral InformationNote: Please enter the full name of the student you referred or the full name of your referrer.Parent/Guardian Name 1 *FirstLastParent/Guardian Email 1 *Parent/Guardian Phone Number 1 *Parent/Guardian Name 2FirstLastParent/Guardian Email 2Parent/Guardian Phone Number 2Home Address *Payment *ZelleWe will send an invoice after receiving your registration form. We accept payment via Zelle. Registration is not confirmed until payment is received.Waiver of Liabilities *Parent(s)/Guardian(s) agree to indemnify and hold harmless Golden Bear Education, its board members, administrators, directors, staffs, teachers, volunteers and service providers from all liabilities and claims, of whatever nature, including but not limited to the infection of communicable diseases, with regard to the child’s enrollment in the programs Golden Bear Education provided.Note: By checking this checkbox above, parent(s)/guardian(s) are electronically signing this waiver of liabilities and agree to the terms and conditions.Questions or ConcernsIf you have any questions or concerns, please feel free to contact us.CommentSubmit
