REGISTRATION (A+UP)

registration procedures (please read carefully!)

1) This form must be filled out online at time of registration. No exceptions! 

2) The one-time registration fee of $50 must be submitted as well as the first month's tuition. These fees are NON-REFUNDABLE after registration is submitted. Please indicate what date you would like your student to start, and you will be invoiced for these fees.

3) Applications will not be processed and no child will be picked up by Old School until all required forms and registration payment is complete.

4) Invoices will be sent to the designated parent e-mail provided in the "Parent 1" line of this form. Payments can be made via the link within the e-mailed invoice.

Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Child's Primary Address *
Child's Primary Address
Parent 1 *
Parent 1
Parent 1 Phone Number *
Parent 1 Phone Number
Parent 2
Parent 2
Parent 2 Phone Number
Parent 2 Phone Number
Child Lives With *
Parent Marital Status *
Medical/ Personal Information *
Please check all that apply so that we can better assist your child. *Please note, Old School may not be able to accommodate certain needs. If you have questions about whether we are equipped to work with your child, please contact us at 713-510-3102.
Please list any food allergies, asthma, special needs, existing conditions and/or prescribed medications. If your child does not have any of these simply write "none". For food allergies please also list their severity.
Emergency Contact 1 *
Emergency Contact 1
Emergency Contact 1 Phone Number *
Emergency Contact 1 Phone Number
Emergency Contact 2
Emergency Contact 2
Emergency Contact 2 Phone Number
Emergency Contact 2 Phone Number
Media Release *
Old School may at any point take photographs or video of our program at work for such purposes as publicity, illustration, advertising, and web content. I grant Old School LLC and it's representatives and employees permission to take such photographs or videos of my child.
Parent Permission *
Old School ASC will be planning recreational activities for my child and screen a movie for kids on occasion. All movies shown are PG or G rated. If you object to your child watching or specific content please notify your site director in writing. I hereby grant Old School permission to plan daily activities for my child to take part in and to screen movies for my child.
Medical Authorization & Permission to Treat *
I hereby grant Old School ASC permission to take whatever action in its judgement may be necessary in supplying emergency medical services to the named child. I understand that, consistent with the circumstances of the situation and available time, Old School ASC will make every effort to contact and follow the instructions of the parent or legal guardian. I hereby Agree that I will be solely responsible for and will pay promptly any expenses which may be incurred by Old School ASC in making emergency medical treatment to named child.