STEP 1 OF 2

Entrance Date
Entrance Date
Withdrawl Date
Withdrawl Date
Parent / Guardian *
Parent / Guardian
Address *
Address
Primary Contact Number *
Primary Contact Number
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Number *
Emergency Contact Number
Child to be Enrolled in GTA
Child's Name *
Child's Name
Age *
Age
Including any special needs, accommodations, medication(s), pre-existing illness, allergies or health concerns.
Parent / Guardian Pick-Up Authorization *
I will sign out my child as I come to pick him/her up. I will personally escort my child from the program area. I will supply in writing the required information of those who are authorized to pick-up my child. I understand that any changes to pick up list must be made in writing and I also understand that the receipt of any changes must be confirmed by Global Tech Academy Inc. staff in writing. The adults I have listed below are AUTHORIZED to pick-up my child. I understand that adults authorized to pick-up my child must present a valid photo ID (preferably a state driver’s license or other form of government-issued identification). I understand that if the name and address listed on the ID card does not EXACTLY MATCH that of the person picking up my child, my child may not be released. I understand the Global Tech Academy Inc. staff will ONLY release a child to authorized adults listed below or adults listed as emergency contacts. I understand that authorized adults must be 18 or older.
Acknowledgement of Policies & Guidelines *
By checking the box below, I acknowledge that I have read the above information, and that I understand the policies and guidelines of the program and I agree to abide by them. Should I have any questions or concerns, I will contact the Program Director. I understand that the staff makes every effort to provide a quality program, but additionally it is important that participants and parents follow all rules, guidelines and procedures in order for the program to be a successful experience for all.
Emergency Medical Authorization *
Should my child or children suffer an injury or illness while in the care of Global Tech Academy and they are unable to contact me (us) immediately, it shall be authorized to secure such medical attention and care for my child / children as may be necessary. I (We) shall assume responsibility for payment for services.
Child's Doctor *
Child's Doctor
Doctor / Clinic Contact Number *
Doctor / Clinic Contact Number
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Dear Families:

We would like to take this opportunity to welcome you and your child to Global Tech Academy Inc. (GTA) Afterschool Enrichment program. Global Tech Academy Inc. is an exciting new technological computer enrichment program that's empowering a new generation of students who are serious about their future.

At Global Tech Academy Inc., our mission is: to empower a new generation of students by integrating technology programs into everyday life to pave the way for the future and to be a company that implements genuine care, respect and courtesy for children, parents and each other.

The goals of GTA afterschool program is to provide a quality program that is safe, fun and affordable. Our programs offer age appropriate activities under the supervision of competent, trustworthy, caring and qualified staff that understands and meets the needs of the children in our care.

To meet the physical, intellectual, social, emotional and recreational needs of children, our program will:

  • Offer fun, enriching, academically oriented and recreational activities that help promote confidence, self-esteem and responsibility.
  • Provide children a safe and secure environment staffed by warm, friendly childcare professionals.
  • Provide a relaxed atmosphere where children can socialize and make new friends.
  • Provide a nutritional snack.
  • Provide tutoring and homework assistance.

At GTA, we believe that during the hours that the children are away from home they should be provided with a quality program of well supervised activities that stimulates new interests, encourages creativity and builds self confidence, while providing their parents with “peace of mind.”

We are looking forward to providing you and your child with a quality afterschool enrichment program.

Sincerely,

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