Children’s Activities After Three Programs CAAT PROGRAM Payments This Form Is To Be Used by UAU Administration Only Δ I Would Like To Register for the CAAT Program At:(Required)Select the school program site.Select Program SitePS 1PS 5PS 6PS 8PS 13PS 38PS 39PS 45PS 120I Would Like To Register for Early Drop Off At PS 8PS 8 is the only site offering an early drop off program at 7:30am. You can register for early drop off only, or early drop off can be added in addition to the CAAT program at PS 8.Select Number of ChildrenOne Child $130 Per MonthTwo Children $260 Per MonthThree Children $390 Per MonthNumber of Students I Am Enrolling:(Required)You will be automatically billed each month for the program based on number of students enrolled. Automatic payments will occur roughly 30 days from the date you register. Please note registration also includes a credit card convenience fee.Select Number Of Children1 Student: $298.71 Per month2 Students: $530.25 Per Month3 Students: $736 Per MonthStudents Name:(Required) First Last Current Grade Child Is In:(Required)Current Class Child Is In:(Required)Student Two Name:(Required) First Last Current Grade Child Is In:(Required)Current Class Child Is In:(Required)Student Three Name:(Required) First Last Current Grade Child Is In:(Required)Current Class Child Is In:(Required)Home Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home Phone Number(Required)Parent/Guardian One(Required) First Last Parent/Guardian One Email Address:(Required) Enter Email Confirm Email Parent/Guardian One Employer(Required)Type NA if unavailable Parent/Guardian One Employer Address:(Required)Type NA in fields if no applicable Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Parent/Guardian One Cell Phone:(Required)Parent/Guardian One Work Number(Required)Parent/Guardian Two Name: First Last Parent/Guardian Two Email Address: Enter Email Confirm Email Parent/Guardian Two Employer:Parent/Guardian Two Employer Address: Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Parent/Guardian Two Cell Phone:Parent/Guardian Two Work NumberEmergency Contact InformationIn case of an emergency and the parent/guardian listed above cannot be reached please list two other individuals as points of contact.Emergency Contact 1 Name:(Required) First Last Emergency Contact Cell Phone Number(Required)Relationship To Child:(Required)Emergency Contact 2 Name:(Required) First Last Relationship To Child:(Required)Emergency Contact 2 Cell Phone Number(Required)Emergency Medical TreatmentIt is understood that the final disposition in an emergency case, the judgment of the camp authorities will prevail. The recommendation of the parent as indicated below will be respected as far as possible.Doctor's Name:(Required) First Last Doctor's Phone Number(Required)Should Any Activity Be Restricted? Please list any/all here along with reason why.(Required)Including Allergies, Physical Limitations Etc.Allergies To Food?(Required) Yes No Convulsions/Seizures?(Required) Yes No Allergies to Medicine?(Required) Yes No Corrective Device?(Required)Glasses, hearing aid, etc Yes No Diabetes?(Required) Yes No Asthma?(Required) Yes No Behavioral/Emotional Issues?(Required) Yes No Physical Disabilities?(Required) Yes No Does Your Child have special health care needs that require treatment?(Required) Yes No Does Your Child take any medication for any condition or illness?(Required) Yes No If You Answered YES to any of the above questions please provide an explanation below:(Required)Child's Medical Form(Required)Please upload your child's physical form by clicking browse files. Form must be from within the last 12 months to be considered valid.Max. file size: 128 MB. Consent(Required)By submitting and digitally signing this registration form I agree to the following: -To have my child treated for any non-emergency situations -In case of an accident or injury, emergency medical care may be given in the event i cannot be reached -I understand that this consent will be in effect as of the date of my signing this form and will continue as long as my child is enrolled in this after-school program. -I certify that all the information provided on this form are true and correct. I will abide by all applicable rules and regulations of the program. I consent to the enrollment and participation of the child/children listed above in this program. I understand that if my child has a seizure or any other unanticipated medical reaction while attending this program, I will not hold UAU responsible. Parents, guardians, participants, and UAU recognize that the activities to be engaged in by the participants may occasionally result in injury to a child. The staff of UAU will make sure the proper attention is given in the event of illness/accidents, and emergency care. No liability will be asserted nor claim made against UAU or any of the individuals employed by UAU by reason of such an event. I acknowledge that I have read this consent form, and knowingly, on behalf of my child, assume all of the risks associated with participating in any way in the UAU program. I agreeConsent(Required)Refunds are available for up to 50% of the original payment amount and must be requested within 30 days of the payment date. Requests made after 30 days will not be eligible for a refund. All refund decisions are final and subject to the terms outlined at the time of purchase. I have read and understand the refund policyConsentView the CAAT Handbook 2025 I have read and understand the student handbookSignature(Required)Your NameYour NameYour NameYour NameToday's Date(Required) Total Payment Option(Required)Please select how you will be paying your balance noted above.SelectVoucherCashVoucher Number:(Required)To Whom Was Payment Given?(Required) First Last
