/ Allstars Academy After-School Programs
Allstars Academy After-School Programs
2023 After School
Child's Date of Birth
Enter Current School Name
ZIP / Postal Code
List all individuals authorized to pick up your child (other than the child’s parents and emergency contacts listed above who are automatically authorized to pick up your child). Identification may be requested from listed individuals.
Emergency Medical Information
Doctor Phone Number
List all medical and special conditions such as allergies to food, medicine, etc
Any additional information you want to provide us
Date you want to start in the program
Select the school/location where you wish the child to be picked up from
Carolyn Clark Elementary School
Chaboya Middle School
Evergreen Elementary School
James F. Smith School
Tom Matsumoto Elementary School
Quimby Middle School
Silver Oak Elementary School
Millbrook Elementary School
Cadwallader Elementary School
John J. Montgomery Elementary School
Holly Oak Elementary School
Silver Oak Elementary School
Select the After School Program
After School Program
After School Program (with transportation from school to Grace Church)
Kinder Early Release for first 12 days of school
Kinder and TK program - first 2 weeks of early release (August 17 - September 2)
I hereby instruct ALLSTARS UNITED EDUCATION FOUNDATION ("AUEF") to use the email addresses on this registration for all communications from AUEF to us until we notify AUEF at email@example.com of an alternate address. If we do not have access to email, AUEF will use the phone numbers on this registration.
I hereby give my consent to have an athletic trainer, teacher, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with event activities, and hereby release, discharge, and otherwise indemnify AUEF, US Club Soccer, AYSO, AAU, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the applicant/participant registering herein as a result of that applicant/participant participation in Programs selected above.
I acknowledge that I understand that all registration fees paid are non-refundable.
I accept the terms of the Waiver above.
* Registration Fee - $75
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