After-School Care Enrollment Form

Dear Parents and Applicant:

Thank you for your interest in the After-School Care Program at UAP. Please fill out this application form completely. The hours of after-school care are from 2:30-3:30 for Pre-K students only, at $200 per child monthly. The hours of after-school care are from 3:30pm - 5:30pm for Pre-K to 8th grade students, at $400 per child monthly. Your child will not be registered until a payment is made. Any student who has received disciplinary actions or suspended may not be able to attend the after-school program.

* Indicates required field

Student Name *

First

Last

Grade *

Parent / Guardian Name *

Parent / Guardian Phone Number *

Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

I understand that my child must be picked-up on time or an additional fee may be applied *

Agree Disagree

I understand that my child must display positive behavior during and after school or this privilege may be revoked. *

Agree Disagree

Signature of Parent / Guardian *

Today's Date *

Submit

Email: info@uapschool.org
Phone: 412-241-2124
Fax: 412-241-2123

Universal Academy of Pittsburgh
2103 Hampton Street
Pittsburgh PA 15218