FCA Tyler Aftercare Program Application

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Email *

Program will be held 3:15-5:30 each school day beginning Wednesday, August 16, 2023

Mrs. Paula Biddle is the TCA Aftercare Program Coordinator for the 2023-2024 school year. For general program information, please contact her at pbiddle@responsiveedtx.com. For questions about enrollment, waiting lists, or fees please contact Bridgette Ray at bnray@responsiveedtx.com

Student Name *

Desired program start date *

YYYY

Student grade *

Additional students and grade level

Student lives with *

both parents

father

mother

other

Parent/ guardian name *

Student address *

Phone number (this will be used for aftercare remind messaging) *

Email address for communication about TCA After-Care Program including billing notices and other information. It is your responsibility to check this email address regularly. *

Permission for Pick-Up: Only individuals listed on this form will be allowed to pick-up students from the After-School Care Program without prior written approval. The primary person(s) picking up my child/children on a normal daily basis is: *

Additional people allowed to pick up my child: (please include name and phone number) *

Authorization for Emergency Medical Treatment: I give consent for Tyler Classical Academy After-School Care Program to secure any and all necessary emergency medical care needed for my child. *

Yes, I consent for Tyler Classical Academy After-School Care Program to secure any and all necessary medical care for my child.

No, I do not agree.

Please list any allergies or medical conditions that the program staff needs to ensure the safety of your child. (answer NA if none) *

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