Rockin' Jump Myrtle Beach

After School Care Registration Form

This registration form is for our After School Care program. If you are looking for Holiday Care registration, please click here.

PARENT/GUARDIAN INFORMATION:

CHILD'S INFORMATION:

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MEDICAL INFORMATION:

ADDITIONAL EMERGENCY CONTACTS & AUTHORIZED PICK UPS:

Please list the individuals other than the parent/guardian listed above who may pick up your child. Check to indicate who we may contact in the event of an emergency if parent/guardian cannot be reached.

PROGRAM POLICIES:

Cancellation & Refund Policy - Changes or cancellations must be made in writing at least three weeks in advance of the After School Care start date to receive a refund. A $25 cancellation fee per person will be deducted from the refund amount. Cancellations made less than three weeks in advance will not receive a refund. Rockin' Jump reserves the right to adapt or cancel sessions due to under enrollment, inclement weather, and other factors out of our control in which case the child will receive a full refund.

Behavior - I understand that my child’s behavior should meet the following expectations:

  • Use of appropriate language at all times.
  • Cooperate with the Rockin' Jump staff and follow all directions.
  • Maintain a positive attitude.
  • Respect other kids, staff, equipment, and facilities.
  • Stay in program areas; running away is not acceptable.
  • Participate in the program.

The following behaviors can result in immediate suspension or dismissal from the program, but are not limited to:

  • Fighting, biting, or running away.
  • Possession of a weapon of any kind
  • Sexual misconduct
  • Vandalism, destruction, or theft of Rockin' Jump property or property of others
  • Any action that threatens the physical/emotional safety of the child, other children, or staff.

Discipline Policy - I understand that the discipline policy is as follows:

  • If my child is unable to follow Rockin' Jump’s behavior expectations, they will be given a verbal warning and will have a conversation with the program director. The parent/guardian will be notified.
  • If my child is still unable to follow Rockin' Jump’s behavior expectations after the first conversation, the program director will have a second conversation with the parent.
  • If my child is still unable to follow Rockin' Jump’s behavior expectations, they will be subject to suspension or dismissal. I understand that a refund is not issued if my child is suspended or dismissed from the program.

Personal Items - I understand that Rockin' Jump is not responsible for any personal items lost or stolen at our program.

Inclement Weather - I understand that the program is subject to be closed if there is inclement weatherand that there will be no make up offered due to inclement weather.

Cancellations - A two week notice is required to cancel After School Care in order to receive a full refund.

Payment - I understand that full payment is due on the first day of After School Care. I understand that my child is not allowed to participate in the program if funds are not paid in full on that date.

Refunds - I understand that failure to attend does not entitle me to a refund. I understand that no refunds or price adjustments are given for vacation, illness, suspension or dismissal from the program, or program closings due to inclement weather.

Emergency - I understand that in the event of an emergency, if the parent/guardian or listed emergency contacts cannot be reached, Rockin' Jump will contact EMS and take the appropriate actions that are in Rockin Jump’s judgment to be in the best interest of my child.

Medication - I understand that Rockin' Jump is not normally allowed to administer any medication to my child and will do so only with written consent from the parent/guardian. Medication must be kept in its original container with written instructions on how to administer it to the child. Do not send medication with the child. The medication must be handed to a Rockin' Jump staff member.


I have read, understand and agree with all of the above policies and will discuss the behavior expectations with my child. I understand that Rockin' Jump has the right to revoke my child’s participation in Rockin' Jump programs for behavior that is not within the guidelines of the behavior policies and procedures. My signature below indicates that I agree to all that this document entails.

Please type your full name (First and Last).