Before & After Care Application

I understand that Magna Prep will begin on Monday, August 24, 2026 and end on Friday, June 4, 2026: *

Start date for youth admission? *

Month

Day

Year

I Understand my child's birth certificate, physical, and my ID must be uploaded or email for services to begin? *YesNo

Upload items/ email Administration@magnaexperiennce.com (please write down).

No file chosen

I understand the official start time is 2pm, and that youth may not arrive after the start time. Unless there is an early dismissal. *

I understand youth are to be picked up and off the premises of the program by 5:30 pm: *YesNo

I understand that Magna Prep will provide the opportunity for youth to participate in activities and academic assistance: *

What are your child strengths & weakness in regards to his/her academics:?

I understand that snack will be provided or youth can bring their own? *YesNo

I understand that youth are responsible for their belongings? *

I understand to put my child’s name on all their belongings: *

I understand the program is not are responsible for electronic devices? *

I understand Magna Prep reserves the right to terminate the services of any youth that demonstrates disruptive or unsafe behavior with no refund? *

Do you have "subsidy" or "private pay" method? *Subsidy/CopayPrivate Pay (Cash/Debit)

Which payment arrangement do you prefer: *

I understand the late fee is $5 every five minutes after 5:30PM? *YesNo

I understand that, as the guardian it's my responsibility to keep note of the School closures, early dismissals, and inclement weather days? *

I understand I can contact staff via phone/text at 1(888)581-7737? *YesNo

I received complete written program information at the time of enrollment? *

I agree to update the emergency contact/parental consent form whenever information changes occur or every 6 months? *YesNo

Parent/Guardian Name *

Date *

Staff Name

Date

Youth Name *

Date Of Birth *

Grade *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Parent/ Legal Guardian Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Phone *

Email Address *

Place of Employment *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Work Phone *

Parent/ Legal Guardian Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Email Address

Place of Employment

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Work Phone

Emergency Contact Name *

Youth may be released to this emergency contact? *

Street Address *

City

State/Province

ZIP / Postal Code

Phone

Emergency Contact Name *

Youth may be released to this emergency contact? *

Street Address *

City

State/Province

ZIP / Postal Code

Phone *

Name Of Child’s Physician/Medical Provider *

Phone *

Street Address *

City

State/Province

ZIP / Postal Code

Special Disabilities (If Any) *

Allergies(Including Medication Reaction) *

Medical or Dietary Information In An Emergency Situation *

Medication , Special Situation) *

Additional Information On Special Needs Of Youth:

Health Insurance Coverage or Medical Assistance: *

Policy Number *

Youth can obtain emergency medical care: *

Staff can administer minor First-Aid Procedures: *

Youth Can Be Transported *

Youth May Walk/Trips *

Youth May Go Wading? *

Youth May Go Swimming? *

How will your youth be dismissed from the program? *Picked UpWalk HomePicked Up/Walk Home

Parent/Guardian Name *

Date *