Adventure Club Enrollment Form | The Adventure Club

Adventure Club School Enrollment

"*" indicates required fields

TO AVOID DELAY IN ENROLLMENT, PLEASE COMPLETE THIS FORM IN IT’S ENTIRETY!

How did you hear about us?*

Facebook

Open House

A Friend

Google

Roadside Advertisement

Brochure

Referral Source:*

If a currently enrolled family referred you to our program, and you have never been enrolled in our program before, please share with us the First & Last name of the parent referral. They will receive a $25 in-house credit as long as they’re actively enrolled.

(Please type “N/A” if this does not apply)

School Semester Enrollment Selection ~ Please choose one of the following:*

2023-24 CURRENT Fall Semester (August 16, 2023 – December 21, 2023)

2024 Spring Semester (January 8, 2024 – May 22, 2024)

BOTH 2023-24 CURRENT Fall Semester & 2024 Spring Semester

If you are applying for both the CURRENT 2023-24 Fall Semester as well as the 2024 Spring Semester, you will be billed a non-refundable registration fee of $50 per child for each semester!

Childcare Payment Assistance ~ Please choose one of the following:*

I DO NOT receive state subsidy assistance, foster care, or Swift Start assistance.

I am currently approved and receiving subsidy childcare assistance.

I have applied for subsidy assistance and I am currently on the wait list. STOP! You will be responsible for ALL fees and tuition until approved.

My child is part of the foster care system. All foster families are responsible for payment of tuition & obtaining reimbursement from social services.

I am currently approved through Swift Start.
Parents are responsilble for any monthly co pay outlined by the Department of Social Services as well as any weekly difference there may be in tuition and what DSS pays.

Which county are you receiving assistance from:*

Montgomery County

Floyd County

Giles County

Pulaski County

Radford City

Carroll County

Other – county is not listed above

Other county you are receiving assistance from:*

DSS Subsidy Policy*
Child care subsidy that is paid through the Department of Social Services must meet the following requirements to be actively enrolled at The Adventure Club:

1. Parents/Legal Guardian must swipe their card each morning and afternoon.

2. A Child will not be able to attend the program unless the DSS card is swiped.

3. Parents must swipe BEFORE checking into Procare (our accounting/attendance system) or signing in children.

4. If a parent forgets the DSS card, a child will not be allowed to attend until the card is swiped. (Taking a photo of your card for manual entry is a good way to have back up if your card is lost)

5. If a parent has a co-fee, those fees are collected in advance before services are rendered. A credit card or checking account is required for automatic debit.

6. If a child is absent, the back swipe must be done the following day the child returns. Any unapproved absences will be the responsibility of the parent to pay.

Acknowledgement: I have read and will abide by the policies listed above.

Child Information & Consents:

REQUIRED DOCUMENTS – NEW FAMILIES ONLY!
UPLOAD:

1. Proof of birth (BIRTH CERTIFICATE), recent immunizations, and last physical/well visit. Your child CANNOT START UNTIL RECEIVED!

2. Parents are required to obtain these documents. ADVENTURE CLUB DOES NOT REQUEST DOCUMENTS FROM THE SCHOOLS! Click this link to complete needed forms if you have not done so already for the school:
School Entrance Health Form (PDF)

— THESE MUST BE COMPLETED BY YOUR CHILD’S PHYSICIAN.

3. YOU MAY UPLOAD THEM BELOW, FAX to 540-382-6529 , SCAN & EMAIL to: [email protected] OR upload them to your Parent Portal APP (Link sent upon enrollment)

Drop files here or

Max. file size: 100 MB.

How many children are you enrolling?*

Program Start Date?*

MM slash DD slash YYYY

1st Child Info:

1st Child:*
1st Child:

Gender First “Nickname” Last

Date of Birth:*

Which Program Site will your 1st child attend?*
Enrollment for the “BEFORE & AFTER” Program: Available for children needing care before and/or after school care paying a flat weekly rate.

Child Care on NON-SCHOOL DAYS: Located at: 77 Scattergood Drive in Christiansburg * If you only need care for your child age 5-10 yrs on NON-School days, you may enroll for Non-School Day Care Only at the daily rate of $90 per child, each day. * If your child is enrolled for Before & After care at one of our school sites, they will attend 77 Scattergood Drive in Christiansburg on all NON-School days at a rate of $45 per child, each day. * We provide breakfast, afternoon snack (parents need to pack a lunch), STEM activities, board games, arts & crafts, large indoor area for team games and physical activity, and outdoor play.

Auburn Elementary within the school

Christiansburg Elementary @ 77 Scattergood Drive in Christiansburg for all care — MCPS bus will transport children to and from school *no transport fee*

Christiansburg Primary @ 77 Scattergood Drive in Christiansburg for all care — MCPS bus will transport children to and from school *no transport fee*

Falling Branch Elementary @ 77 Scattergood Drive in Christiansburg for all care — TAC vans w/ transport to and from school *additional fee see rate sheet*

NON ENROLLED – Non-School Day Care @ 77 Scattergood Drive in Christiansburg (For Teacher Workdays, Holidays, & Inclement Weather Days) *$90/child/day*

1st Child: Allergies, Special Needs, or Medication:*
If medication needs to be administered, please click the link below to the Medicine Consent Form and have the pediatrician complete it. With the completed form, provide your child’s medicine in its original box to the director of the center. Describe any specific details in the box below. ***IF FILLING OUT A FORM, YOU WILL NEED TO EITHER UPLOAD IT BELOW, SCAN & EMAIL IT TO [email protected] OR Fax it to us at 540-382-6529***

Medication Consent (PDF)
VA Athsma Action Plan (PDF)
General Healthcare Plan (PDF)
Food Allergy & Anaphylaxis Emergency Care Plan (PDF)

Special Needs or Medication Details:

NEW FAMILIES ONLY — REQUIRED DOCUMENTS!
UPLOAD MEDICAL DOCUMENTS HERE:

Max. file size: 100 MB.

What will be your 1st child's attendance status:*

Morning (AM) care only

Afternoon (PM) care only

Morning & Afternoon (AM & PM) care

Non-School Day Care ONLY — $90/child/day

New or Returning?:*
(Subsidy families pay enrollment fees if DSS does not)

What Grade is your child going into?*

2nd Child Info:

2nd Child:*
2nd Child:

Gender First “Nickname” Last

Date of Birth:*

Which Program Site will your 2nd child attend?*
Enrollment for the “BEFORE & AFTER” Program: Available for children needing care before and/or after school care paying a flat weekly rate.

Child Care on NON-SCHOOL DAYS: Located at: 77 Scattergood Drive in Christiansburg * If you only need care for your child age 5-10 yrs on NON-School days, you may enroll for Non-School Day Care Only at the daily rate of $90 per child, each day. * If your child is enrolled for Before & After care at one of our school sites, they will attend 77 Scattergood Drive in Christiansburg on all NON-School days at a rate of $45 per child, each day. * We provide breakfast, afternoon snack (parents need to pack a lunch), STEM activities, board games, arts & crafts, large indoor area for team games and physical activity, and outdoor play.

Auburn Elementary within the school

Christiansburg Elementary @ 77 Scattergood Drive in Christiansburg for all care — MCPS bus will transport children to and from school *no transport fee*

Christiansburg Primary @ 77 Scattergood Drive in Christiansburg for all care — MCPS bus will transport children to and from school *no transport fee*

Falling Branch Elementary @ 77 Scattergood Drive in Christiansburg for all care — TAC vans w/ transport to and from school *additional fee see rate sheet*

NON ENROLLED – Non-School Day Care @ 77 Scattergood Drive in Christiansburg (For Teacher Workdays, Holidays, & Inclement Weather Days) *$90/child/day*

2nd Child: Allergies, Special Needs, or Medication:*
If medication needs to be administered, please click the link below to the Medicine Consent Form and have the pediatrician complete it. With the completed form, provide your child’s medicine in its original box to the director of the center. Describe any specific details in the box below. ***IF FILLING OUT A FORM, YOU WILL NEED TO EITHER UPLOAD IT BELOW, SCAN & EMAIL IT TO [email protected] OR Fax it to us at 540-382-6529**

Medication Consent (PDF)
VA Athsma Action Plan (PDF)
General Healthcare Plan (PDF)
Food Allergy & Anaphylaxis Emergency Care Plan (PDF)

Special Needs or Medication Details:

NEW FAMILIES ONLY — REQUIRED DOCUMENTS!
UPLOAD MEDICAL DOCUMENTS HERE:

Max. file size: 100 MB.

What will be your 2nd child's attendance status:*

Morning (AM) care only

Afternoon (PM) care only

Morning & Afternoon (AM & PM) care

Non-School Day Care ONLY — $90/child/day

New or Returning?:*
(Subsidy families pay enrollment fees if DSS does not)

What Grade is your child going into?*

3rd Child Info:

3rd Child:*
3rd Child:

Gender First “Nickname” Last

Date of Birth:*

Which Program Site will your 3rd child attend?*
Enrollment for the “BEFORE & AFTER” Program: Available for children needing care before and/or after school care paying a flat weekly rate.

Child Care on NON-SCHOOL DAYS: Located at: 77 Scattergood Drive in Christiansburg * If you only need care for your child age 5-10 yrs on NON-School days, you may enroll for Non-School Day Care Only at the daily rate of $90 per child, each day. * If your child is enrolled for Before & After care at one of our school sites, they will attend 77 Scattergood Drive in Christiansburg on all NON-School days at a rate of $45 per child, each day. * We provide breakfast, afternoon snack (parents need to pack a lunch), STEM activities, board games, arts & crafts, large indoor area for team games and physical activity, and outdoor play.

Auburn Elementary within the school

Christiansburg Elementary @ 77 Scattergood Drive in Christiansburg for all care — MCPS bus will transport children to and from school *no transport fee*

Christiansburg Primary @ 77 Scattergood Drive in Christiansburg for all care — MCPS bus will transport children to and from school *no transport fee*

Falling Branch Elementary @ 77 Scattergood Drive in Christiansburg for all care — TAC vans w/ transport to and from school *additional fee see rate sheet*

NON ENROLLED – Non-School Day Care @ 77 Scattergood Drive in Christiansburg (For Teacher Workdays, Holidays, & Inclement Weather Days) *$90/child/day*

3rd Child: Allergies, Special Needs, or Medication:*
If medication needs to be administered, please click the link below to the Medicine Consent Form and have the pediatrician complete it. With the completed form, provide your child’s medicine in its original box to the director of the center. Describe any specific details in the box below. ***IF FILLING OUT A FORM, YOU WILL NEED TO EITHER UPLOAD IT BELOW, SCAN & EMAIL IT TO [email protected] OR Fax it to us at 540-382-6529**

Medication Consent (PDF)
VA Athsma Action Plan (PDF)
General Healthcare Plan (PDF)
Food Allergy & Anaphylaxis Emergency Care Plan (PDF)

Special Needs or Medication Details:

NEW FAMILIES ONLY — REQUIRED DOCUMENTS!
UPLOAD MEDICAL DOCUMENTS HERE:

Max. file size: 100 MB.

What will be your 3rd child's attendance status:*

Morning (AM) care only

Afternoon (PM) care only

Morning & Afternoon (AM & PM) care

Non-School Day Care ONLY — $90/child/day

New or Returning?:*
(Subsidy families pay enrollment fees if DSS does not)

What Grade is your child going into?*

4th Child Info:

4th Child:*
4th Child:

Gender First “Nickname” Last

Date of Birth:*

Which Program Site will your 4th child attend?*
Enrollment for the “BEFORE & AFTER” Program: Available for children needing care before and/or after school care paying a flat weekly rate.

Child Care on NON-SCHOOL DAYS: Located at: 77 Scattergood Drive in Christiansburg * If you only need care for your child age 5-10 yrs on NON-School days, you may enroll for Non-School Day Care Only at the daily rate of $90 per child, each day. * If your child is enrolled for Before & After care at one of our school sites, they will attend 77 Scattergood Drive in Christiansburg on all NON-School days at a rate of $45 per child, each day. * We provide breakfast, afternoon snack (parents need to pack a lunch), STEM activities, board games, arts & crafts, large indoor area for team games and physical activity, and outdoor play.

Auburn Elementary within the school

Christiansburg Elementary @ 77 Scattergood Drive in Christiansburg for all care — MCPS bus will transport children to and from school *no transport fee*

Christiansburg Primary @ 77 Scattergood Drive in Christiansburg for all care — MCPS bus will transport children to and from school *no transport fee*

Falling Branch Elementary @ 77 Scattergood Drive in Christiansburg for all care — TAC vans w/ transport to and from school *additional fee see rate sheet*

NON ENROLLED – Non-School Day Care @ 77 Scattergood Drive in Christiansburg (For Teacher Workdays, Holidays, & Inclement Weather Days) *$90/child/day*

4th Child: Allergies, Special Needs, or Medication:*
If medication needs to be administered, please click the link below to the Medicine Consent Form and have the pediatrician complete it. With the completed form, provide your child’s medicine in its original box to the director of the center. Describe any specific details in the box below. ***IF FILLING OUT A FORM, YOU WILL NEED TO EITHER UPLOAD IT BELOW, SCAN & EMAIL IT TO [email protected] OR Fax it to us at 540-382-6529**

Medication Consent (PDF)
VA Athsma Action Plan (PDF)
General Healthcare Plan (PDF)
Food Allergy & Anaphylaxis Emergency Care Plan (PDF)

Special Needs or Medication Details:

NEW FAMILIES ONLY — REQUIRED DOCUMENTS!
UPLOAD MEDICAL DOCUMENTS HERE:

Max. file size: 100 MB.

What will be your 4th child's attendance status:*

Morning (AM) care only

Afternoon (PM) care only

Morning & Afternoon (AM & PM) care

Non-School Day Care ONLY — $90/child/day

New or Returning?:*
(Subsidy families pay enrollment fees if DSS does not)

What Grade is your child going into?*

PREVIOUS CHILDCARE NAME – Type N/A if non-applicable.*

FIELD TRIPS:*

PHOTO CONSENT – Photos are reviewed prior to posting on Facebook to ensure proper exposure. TAC WILL NEVER publicly post children's names without parental consent!*

ELECTRONICS & TOYS AGREEMENT: TAC does not allow these items so that your child can fully experience the benefits our program has to offer.*
I Agree to comply with TAC’s “No Electronics or Toys” policy

Medical Information & Consents:

Pediatrician's Name:*

Pediatrician's Phone #:*

SICK POLICY:*
Children’s Health and Safety Policies (A.) Sick Child Procedure – if your child has a temp of over 100 degrees, please keep them home and they can return 48 hours after if fever free without medication. (B.) Daily health checks are conducted every morning upon drop off. (C.) Parents who may not be feeling well – we will deliver your child to you in the parking lot. Please call ahead and we will have your child ready. (D.) Children are required to wash hands when arriving at the facility.
Acknowledgement: I have read and will abide by the policies listed above.

CHILD ILLNESS & COMMUNICABLE DISEASE – If you're notified that your child is ill, you agree to pick your child up within 30 min's or no later than 1 hr. If your child or a member of your immediate household become ill or exposed to a Communicable Disease, you agree to notify TAC within 24 hrs.*
If my child is ill I agree to pick them up. I will notify the center in 24 hrs if exposed to a CD.

EMERGENCY MEDICAL RELEASE & HOSPITAL TRANSPORT – In the event I cannot be reached, I authorize TAC to act on my behalf for my child to receive emergency care, and if deemed necessary, arrange for emergency transport to the hospital of my choice.*

In the event your child sustains an injury while in our care but is NOT transported to the hospital or doctor from our site location, you agree to contact the main office (540-382-3783) within 24 hrs should you decide at a later time to take your child to the hospital or doctor to be evaluated. Per Virginia State Licensing Standards, The Adventure Club is mandated to report any medical treatment sought for the child’s injury after the child has been picked up from our program.

Hospital Preference:*

Specific Instructions for Emergency Medical Care & Hospital Transport:

Parent/Guardian Information:

Who does the child live with?:*

1st Parent Info

Relation to Child:*
1st Parent (Primary Payer):

*

Prefix First Last

*
Full Physical Address (PO Box is not a valid address): City State ZIP Code

Cell Phone #:*

Name of Cell Phone Provider*

Email Address – Please check your email regularly for important notices & account statements.*

Employment Status*
Va state licensing requires that we obtain your current employers address and phone # if you are currently employed.

Employed

Unemployed

Employer's Name:*

*
Employer’s Physical Address (PO Box is not a valid address): City State ZIP Code

Employer's Phone #:*

2nd Parent Info

Relation to Child:*
2nd Parent:

*
Prefix First Last

Is the 2nd parent's physical address the same as the 1st parent?*

Yes

No. Please complete address information below.

*
Full Physical Address (PO Box is not a valid address): City State ZIP Code

Cell Phone #:*

Name of Cell Phone Provider*

Email Address – Please check your email regularly for important notices & account statements.*

Employment Status*
Va state licensing requires that we obtain your current employers address and phone # if you are currently employed.

Employed

Unemployed

Employer's Name:*

*
Employer’s Physical Address (PO Box is not a valid address): City State ZIP Code

Employer's Phone #:*

Authorized Emergency Contacts:

MUST Provide 2 Emergency Contacts that live within 1 hr of child’s location. CANNOT BE PARENT/GUARDIANS!

Prefix:*

1st Emergency Contact:*
1st Emergency Contact:

First Last

Relation to Child:*

Cell Phone #:*

Address:*
Full Physical Address (PO Box is not a valid address): City State ZIP Code

Prefix:*

2nd Emergency Contact:*
2nd Emergency Contact:

First Last

Relation to Child:*

Cell Phone #:*

Address:*
Full Physical Address (PO Box is not a valid address): City State ZIP Code

Parental Agreements:

BEHAVIORAL DISCLOSURE: The Adventure Club Team takes pride in providing a fun and safe environment for all of the children in our program. When parents, children, and The Adventure Club Team are all "on the same page" the children benefit immensely. Please refer to our Parent Handbook for further information.*
BEHAVIORAL DISCLOSURE: The Adventure Club Team takes pride in providing a fun and safe environment for all of the children in our program. When parents, children, and The Adventure Club Team are all “on the same page” the children benefit immensely. Please refer to our Parent Handbook for further information.
I agree and understand the steps The Adventure Club will take if my child does not adhere to these expectations.

Withdrawal Agreement*
WITHDRAWAL AGREEMENT: 1 week written notice of withdrawal MUST be submitted to TAC’s main office via Seer message using the parent portal or an email at [email protected] or additional fees will apply.
I Agree to Submit a 1 Week Written Notice using my parent portal or email.

PARENT HANDBOOK: The Adventure Club reserves the right to make changes to any policy, procedure, tuition rates, fees, or other processes and information in this parent handbook, rate sheets, or our enrollment forms without prior notice. We reserve this right to maintain licensing compliance, stability, and integrity of the programs, and for the safety and security of the children & families enrolled in our programs, and for the staff that our company employs. A copy of our handbook can be found under "Parent Resources" on our website.*
PARENT HANDBOOK: The Adventure Club reserves the right to make changes to any policy, procedure, tuition rates, fees, or other processes and information in this parent handbook, rate sheets, or our enrollment forms without prior notice. We reserve this right to maintain licensing compliance, stability, and integrity of the programs, and for the safety and security of the children & families enrolled in our programs, and for the staff that our company employs. A copy of our handbook can be found under “Parent Resources” on our website.
I agree to review TAC’s Parent Handbook

Parent Electronic Signature for Enrollment:*
First Last

Date Enrollment Submitted:*
MM slash DD slash YYYY

Payment Policies

VERY IMPORTANT ~ PLEASE READ THROUGH CAREFULLY

* NO-PAUSE TUITION ~ Services provided for school sites are retained per contractual agreements with MCPS, therefore tuition fees are charged continuously during each semester (both Fall & Spring).

* ADD-ON DAY FEES ~ Attendance on NON-SCHOOL DAYS of care requires an add-on day fee as outlined in our rate sheet and will be auto debited within 1 business day. ALL full days of care will be hosted at 77 Scattergood Drive in Christiansburg.

* UNPAID TUITION & LATE PAYMENTS ~ Payments can be made automatically using VISA, Mastercard, Discover, or American Express debit/credit cards (fee’s applied for all digital transactions) or by a personal check (no fee applied) given to your child’s Site Manager the THURSDAY prior to the week of attendance. Weekly tuition is processed each THURSDAY prior to week of attendance. If payment is returned for NSF, you will be charged a $35 processing fee. Payment in full will be expected no later than FRIDAY at 6 pm (including a $35 late fee) to avoid suspension of care until the balance is paid.

* LATE PICK-UP FEES ~ Any child clocked out of our system at 6:01pm or later WILL BE CHARGED A FEE, NO MATTER THE REASON FOR BEING LATE! (ie; vehicle breakdown, personal emergency, heavy traffic or car accidents, illness, working later than usual, etc.) Fees are as follows: $10 for the 1st 5 min’s, and $1 a minute thereafter. Fees will be auto debited from your account.

Payment Frequency Options

Payments can be made automatically using VISA, Mastercard, Discover, or American Express debit/credit card (fee’s applied for all digital transactions) or by a personal check (no fee applied) given to your child’s Site Manager the THURSDAY prior to the week of attendance. Weekly tuition is processed each THURSDAY prior to week of attendance.

Non-School Day Care: If you only need care on NON-school days, choose "Non-School Day's Only" ($90/child/day)*

Non-School Day Care:
If you only need care on NON-school days, choose “Non-School Day’s Only” ($90/child/day)

Weekly — (NON-SCHOOL DAYS WILL BE HELD @ 77 SCATTERGOOD DRIVE IN CHRISTIANSBURG)

Non-School Day Care ONLY — (DO NOT CHOOSE THIS IF YOU WANT A WEEKLY BILLING!)

DSS Assisted (Copay if any will be outlined by DSS) — Parents are responsible for any weekly difference if there is one.

Payment Method Selection

How would you like to pay your tuition & fees?*
We accept: Visa, Mastercard, Discover, & American Express. Credit card processing fees will be added on to tuition – Our software does this automatically (processing fee of 3.4% + $0.50 cents per transaction), or Checking Account Withdrawal (ACH) (processing fee of 0.95 % + $0.25 cents per transaction.) — ( Personal Checks are accepted with no additional fee — during the school year checks may be give to your child’s Site Manager each Thursday PRIOR to your child’s attendance the following week )

Credit/Check Card

Checking Withdrawal (ACH)

Personal Check TURNED IN TO YOUR CHILD’S SITE MANAGER OR TAC OFFICE THURSDAY!

Name as it appears on the card or checking account:*
First Last

Billing Address:*
Billing Address City State Zip Code

Phone #:*

Email Address:*

Credit/Check Card #:*

CONFIRM Credit/Check Card #:*

Expiration Date:*

Please enter the month & year in the following format: mm/yyyy

3 digit security code on back of card:*

Name of Financial Institution:*

Routing Number:*

Checking Account Number:*

CONFIRM Checking Account Number:*

Debit Authorization Agreement

Charges that may be automatically debited from your credit card or checking account will include the following as applicable:

* Registration fees (billed upon enrollment each semester). (these fees are Non-Refundable)
* Weekly tuition charges.
* Credit Card – processing fee of 3.4% + $0.50 cents per transaction
* Debit Bank account (ACH) – processing fee of 0.95 % + $0.25 cents per transaction
* Late payment fee of $35.
* Add-On day fees for full days of care $45.
* Late pick-up fee per our policy (see parent handbook).
* Non-Sufficient Funds or Declined Payment fee of $35.
* Early Withdrawal Fee of $50 (min 1 wks written notice required).
* Approval for charges submitted via phone or email authorization.

Payment Agreement Confirmation

.*
By typing my name below, I acknowledge that I have read the payment policies in this agreement. I understand that I am responsible for all tuition & fees that I incur upon receipt of this enrollment and while my child is actively enrolled in TAC and I authorize TAC to debit due charges from my account information provided on this form. I understand that failure to comply with said payment policies could result in applicable late fees, suspension, and/or termination from the program.

Electronic Signature for Payment Agreement:*
First Last

If after clicking submit you remain on the same screen, please scroll back through the form to complete highlighted areas and resubmit.

"*" indicates required fields

TO AVOID DELAY IN ENROLLMENT, PLEASE COMPLETE THIS FORM IN IT'S ENTIRETY!

How did you hear about us?*

Facebook

Open House

A Friend

Google

Roadside Advertisement

Brochure
Referral Source:*
If a currently enrolled family referred you to our program, and you have never been enrolled in our program before, please share with us the First & Last name of the parent referral. They will receive a $25 in-house credit as long as they're actively enrolled.

(Please type "N/A" if this does not apply)

School Semester Enrollment Selection ~ Please choose one of the following:*

2023-24 CURRENT Fall Semester (August 16, 2023 - December 21, 2023)
2024 Spring Semester (January 8, 2024 - May 22, 2024)
BOTH 2023-24 CURRENT Fall Semester & 2024 Spring Semester
If you are applying for both the CURRENT 2023-24 Fall Semester as well as the 2024 Spring Semester, you will be billed a non-refundable registration fee of $50 per child for each semester!
Childcare Payment Assistance ~ Please choose one of the following:*

I DO NOT receive state subsidy assistance, foster care, or Swift Start assistance.

I am currently approved and receiving subsidy childcare assistance.

I have applied for subsidy assistance and I am currently on the wait list. STOP! You will be responsible for ALL fees and tuition until approved.

My child is part of the foster care system. All foster families are responsible for payment of tuition & obtaining reimbursement from social services.

I am currently approved through Swift Start.
Parents are responsilble for any monthly co pay outlined by the Department of Social Services as well as any weekly difference there may be in tuition and what DSS pays.
Which county are you receiving assistance from:*

Montgomery County

Floyd County

Giles County

Pulaski County

Radford City

Carroll County

Other - county is not listed above
Other county you are receiving assistance from:*

DSS Subsidy Policy*
Child care subsidy that is paid through the Department of Social Services must meet the following requirements to be actively enrolled at The Adventure Club:

1. Parents/Legal Guardian must swipe their card each morning and afternoon.

2. A Child will not be able to attend the program unless the DSS card is swiped.

3. Parents must swipe BEFORE checking into Procare (our accounting/attendance system) or signing in children.

4. If a parent forgets the DSS card, a child will not be allowed to attend until the card is swiped. (Taking a photo of your card for manual entry is a good way to have back up if your card is lost)

5. If a parent has a co-fee, those fees are collected in advance before services are rendered. A credit card or checking account is required for automatic debit.

6. If a child is absent, the back swipe must be done the following day the child returns. Any unapproved absences will be the responsibility of the parent to pay.

Acknowledgement: I have read and will abide by the policies listed above.
Child Information & Consents:
REQUIRED DOCUMENTS - NEW FAMILIES ONLY!UPLOAD:

1. Proof of birth (BIRTH CERTIFICATE), recent immunizations, and last physical/well visit. Your child CANNOT START UNTIL RECEIVED!

2. Parents are required to obtain these documents. ADVENTURE CLUB DOES NOT REQUEST DOCUMENTS FROM THE SCHOOLS! Click this link to complete needed forms if you have not done so already for the school:
School Entrance Health Form (PDF)

-- THESE MUST BE COMPLETED BY YOUR CHILD'S PHYSICIAN.

3. YOU MAY UPLOAD THEM BELOW, FAX to 540-382-6529 , SCAN & EMAIL to: [email protected] OR upload them to your Parent Portal APP (Link sent upon enrollment)

Drop files here or

Max. file size: 100 MB.

How many children are you enrolling?*

Program Start Date?*

MM slash DD slash YYYY

1st Child Info:
1st Child:*
1st Child:

Gender First "Nickname" Last
Date of Birth:*

Which Program Site will your 1st child attend?*
Enrollment for the "BEFORE & AFTER" Program: Available for children needing care before and/or after school care paying a flat weekly rate.

Child Care on NON-SCHOOL DAYS: Located at: 77 Scattergood Drive in Christiansburg * If you only need care for your child age 5-10 yrs on NON-School days, you may enroll for Non-School Day Care Only at the daily rate of $90 per child, each day. * If your child is enrolled for Before & After care at one of our school sites, they will attend 77 Scattergood Drive in Christiansburg on all NON-School days at a rate of $45 per child, each day. * We provide breakfast, afternoon snack (parents need to pack a lunch), STEM activities, board games, arts & crafts, large indoor area for team games and physical activity, and outdoor play.

Auburn Elementary within the school

Christiansburg Elementary @ 77 Scattergood Drive in Christiansburg for all care -- MCPS bus will transport children to and from school *no transport fee*

Christiansburg Primary @ 77 Scattergood Drive in Christiansburg for all care -- MCPS bus will transport children to and from school *no transport fee*

Falling Branch Elementary @ 77 Scattergood Drive in Christiansburg for all care -- TAC vans w/ transport to and from school *additional fee see rate sheet*

NON ENROLLED - Non-School Day Care @ 77 Scattergood Drive in Christiansburg (For Teacher Workdays, Holidays, & Inclement Weather Days) *$90/child/day*
1st Child: Allergies, Special Needs, or Medication:*
If medication needs to be administered, please click the link below to the Medicine Consent Form and have the pediatrician complete it. With the completed form, provide your child’s medicine in its original box to the director of the center. Describe any specific details in the box below. ***IF FILLING OUT A FORM, YOU WILL NEED TO EITHER UPLOAD IT BELOW, SCAN & EMAIL IT TO [email protected] OR Fax it to us at 540-382-6529***

Medication Consent (PDF)
VA Athsma Action Plan (PDF)
General Healthcare Plan (PDF)
Food Allergy & Anaphylaxis Emergency Care Plan (PDF)
Special Needs or Medication Details:
NEW FAMILIES ONLY -- REQUIRED DOCUMENTS!
UPLOAD MEDICAL DOCUMENTS HERE:

Max. file size: 100 MB.
What will be your 1st child's attendance status:*

Morning (AM) care only

Afternoon (PM) care only

Morning & Afternoon (AM & PM) care

Non-School Day Care ONLY -- $90/child/day
New or Returning?:*
(Subsidy families pay enrollment fees if DSS does not)
What Grade is your child going into?*

2nd Child Info:
2nd Child:*
2nd Child:

Gender First "Nickname" Last
Date of Birth:*

Which Program Site will your 2nd child attend?*
Enrollment for the "BEFORE & AFTER" Program: Available for children needing care before and/or after school care paying a flat weekly rate.

Child Care on NON-SCHOOL DAYS: Located at: 77 Scattergood Drive in Christiansburg * If you only need care for your child age 5-10 yrs on NON-School days, you may enroll for Non-School Day Care Only at the daily rate of $90 per child, each day. * If your child is enrolled for Before & After care at one of our school sites, they will attend 77 Scattergood Drive in Christiansburg on all NON-School days at a rate of $45 per child, each day. * We provide breakfast, afternoon snack (parents need to pack a lunch), STEM activities, board games, arts & crafts, large indoor area for team games and physical activity, and outdoor play.

Auburn Elementary within the school

Christiansburg Elementary @ 77 Scattergood Drive in Christiansburg for all care -- MCPS bus will transport children to and from school *no transport fee*

Christiansburg Primary @ 77 Scattergood Drive in Christiansburg for all care -- MCPS bus will transport children to and from school *no transport fee*

Falling Branch Elementary @ 77 Scattergood Drive in Christiansburg for all care -- TAC vans w/ transport to and from school *additional fee see rate sheet*

NON ENROLLED - Non-School Day Care @ 77 Scattergood Drive in Christiansburg (For Teacher Workdays, Holidays, & Inclement Weather Days) *$90/child/day*
2nd Child: Allergies, Special Needs, or Medication:*
If medication needs to be administered, please click the link below to the Medicine Consent Form and have the pediatrician complete it. With the completed form, provide your child’s medicine in its original box to the director of the center. Describe any specific details in the box below. ***IF FILLING OUT A FORM, YOU WILL NEED TO EITHER UPLOAD IT BELOW, SCAN & EMAIL IT TO [email protected] OR Fax it to us at 540-382-6529**

Medication Consent (PDF)
VA Athsma Action Plan (PDF)
General Healthcare Plan (PDF)
Food Allergy & Anaphylaxis Emergency Care Plan (PDF)
Special Needs or Medication Details:
NEW FAMILIES ONLY -- REQUIRED DOCUMENTS!
UPLOAD MEDICAL DOCUMENTS HERE:

Max. file size: 100 MB.
What will be your 2nd child's attendance status:*

Morning (AM) care only

Afternoon (PM) care only

Morning & Afternoon (AM & PM) care

Non-School Day Care ONLY -- $90/child/day
New or Returning?:*
(Subsidy families pay enrollment fees if DSS does not)
What Grade is your child going into?*
3rd Child Info:
3rd Child:*
3rd Child:

Gender First "Nickname" Last
Date of Birth:*

Which Program Site will your 3rd child attend?*
Enrollment for the "BEFORE & AFTER" Program: Available for children needing care before and/or after school care paying a flat weekly rate.

Child Care on NON-SCHOOL DAYS: Located at: 77 Scattergood Drive in Christiansburg * If you only need care for your child age 5-10 yrs on NON-School days, you may enroll for Non-School Day Care Only at the daily rate of $90 per child, each day. * If your child is enrolled for Before & After care at one of our school sites, they will attend 77 Scattergood Drive in Christiansburg on all NON-School days at a rate of $45 per child, each day. * We provide breakfast, afternoon snack (parents need to pack a lunch), STEM activities, board games, arts & crafts, large indoor area for team games and physical activity, and outdoor play.

Auburn Elementary within the school

Christiansburg Elementary @ 77 Scattergood Drive in Christiansburg for all care -- MCPS bus will transport children to and from school *no transport fee*

Christiansburg Primary @ 77 Scattergood Drive in Christiansburg for all care -- MCPS bus will transport children to and from school *no transport fee*

Falling Branch Elementary @ 77 Scattergood Drive in Christiansburg for all care -- TAC vans w/ transport to and from school *additional fee see rate sheet*

NON ENROLLED - Non-School Day Care @ 77 Scattergood Drive in Christiansburg (For Teacher Workdays, Holidays, & Inclement Weather Days) *$90/child/day*
3rd Child: Allergies, Special Needs, or Medication:*
If medication needs to be administered, please click the link below to the Medicine Consent Form and have the pediatrician complete it. With the completed form, provide your child’s medicine in its original box to the director of the center. Describe any specific details in the box below. ***IF FILLING OUT A FORM, YOU WILL NEED TO EITHER UPLOAD IT BELOW, SCAN & EMAIL IT TO [email protected] OR Fax it to us at 540-382-6529**

Medication Consent (PDF)
VA Athsma Action Plan (PDF)
General Healthcare Plan (PDF)
Food Allergy & Anaphylaxis Emergency Care Plan (PDF)
Special Needs or Medication Details:
NEW FAMILIES ONLY -- REQUIRED DOCUMENTS!
UPLOAD MEDICAL DOCUMENTS HERE:

Max. file size: 100 MB.
What will be your 3rd child's attendance status:*

Morning (AM) care only

Afternoon (PM) care only

Morning & Afternoon (AM & PM) care

Non-School Day Care ONLY -- $90/child/day
New or Returning?:*
(Subsidy families pay enrollment fees if DSS does not)
What Grade is your child going into?*

4th Child Info:
4th Child:*
4th Child:

Gender First "Nickname" Last
Date of Birth:*

Which Program Site will your 4th child attend?*
Enrollment for the "BEFORE & AFTER" Program: Available for children needing care before and/or after school care paying a flat weekly rate.

Child Care on NON-SCHOOL DAYS: Located at: 77 Scattergood Drive in Christiansburg * If you only need care for your child age 5-10 yrs on NON-School days, you may enroll for Non-School Day Care Only at the daily rate of $90 per child, each day. * If your child is enrolled for Before & After care at one of our school sites, they will attend 77 Scattergood Drive in Christiansburg on all NON-School days at a rate of $45 per child, each day. * We provide breakfast, afternoon snack (parents need to pack a lunch), STEM activities, board games, arts & crafts, large indoor area for team games and physical activity, and outdoor play.

Auburn Elementary within the school

Christiansburg Elementary @ 77 Scattergood Drive in Christiansburg for all care -- MCPS bus will transport children to and from school *no transport fee*

Christiansburg Primary @ 77 Scattergood Drive in Christiansburg for all care -- MCPS bus will transport children to and from school *no transport fee*

Falling Branch Elementary @ 77 Scattergood Drive in Christiansburg for all care -- TAC vans w/ transport to and from school *additional fee see rate sheet*

NON ENROLLED - Non-School Day Care @ 77 Scattergood Drive in Christiansburg (For Teacher Workdays, Holidays, & Inclement Weather Days) *$90/child/day*
4th Child: Allergies, Special Needs, or Medication:*
If medication needs to be administered, please click the link below to the Medicine Consent Form and have the pediatrician complete it. With the completed form, provide your child’s medicine in its original box to the director of the center. Describe any specific details in the box below. ***IF FILLING OUT A FORM, YOU WILL NEED TO EITHER UPLOAD IT BELOW, SCAN & EMAIL IT TO [email protected] OR Fax it to us at 540-382-6529**

Medication Consent (PDF)
VA Athsma Action Plan (PDF)
General Healthcare Plan (PDF)
Food Allergy & Anaphylaxis Emergency Care Plan (PDF)
Special Needs or Medication Details:
NEW FAMILIES ONLY -- REQUIRED DOCUMENTS!
UPLOAD MEDICAL DOCUMENTS HERE:

Max. file size: 100 MB.
What will be your 4th child's attendance status:*

Morning (AM) care only

Afternoon (PM) care only

Morning & Afternoon (AM & PM) care

Non-School Day Care ONLY -- $90/child/day
New or Returning?:*
(Subsidy families pay enrollment fees if DSS does not)
What Grade is your child going into?*
PREVIOUS CHILDCARE NAME - Type N/A if non-applicable.*

FIELD TRIPS:*

PHOTO CONSENT - Photos are reviewed prior to posting on Facebook to ensure proper exposure. TAC WILL NEVER publicly post children's names without parental consent!*

ELECTRONICS & TOYS AGREEMENT: TAC does not allow these items so that your child can fully experience the benefits our program has to offer.*
I Agree to comply with TAC's "No Electronics or Toys" policy

Medical Information & Consents:
Pediatrician's Name:*

Pediatrician's Phone #:*
SICK POLICY:*
Children’s Health and Safety Policies (A.) Sick Child Procedure – if your child has a temp of over 100 degrees, please keep them home and they can return 48 hours after if fever free without medication. (B.) Daily health checks are conducted every morning upon drop off. (C.) Parents who may not be feeling well – we will deliver your child to you in the parking lot. Please call ahead and we will have your child ready. (D.) Children are required to wash hands when arriving at the facility.
Acknowledgement: I have read and will abide by the policies listed above.
CHILD ILLNESS & COMMUNICABLE DISEASE - If you're notified that your child is ill, you agree to pick your child up within 30 min's or no later than 1 hr. If your child or a member of your immediate household become ill or exposed to a Communicable Disease, you agree to notify TAC within 24 hrs.*
If my child is ill I agree to pick them up. I will notify the center in 24 hrs if exposed to a CD.

EMERGENCY MEDICAL RELEASE & HOSPITAL TRANSPORT - In the event I cannot be reached, I authorize TAC to act on my behalf for my child to receive emergency care, and if deemed necessary, arrange for emergency transport to the hospital of my choice.*

In the event your child sustains an injury while in our care but is NOT transported to the hospital or doctor from our site location, you agree to contact the main office (540-382-3783) within 24 hrs should you decide at a later time to take your child to the hospital or doctor to be evaluated. Per Virginia State Licensing Standards, The Adventure Club is mandated to report any medical treatment sought for the child's injury after the child has been picked up from our program.
Hospital Preference:*

Specific Instructions for Emergency Medical Care & Hospital Transport:

Parent/Guardian Information:
Who does the child live with?:*

1st Parent Info
Relation to Child:*
1st Parent (Primary Payer):
*

Prefix First Last
*
Full Physical Address (PO Box is not a valid address): City State ZIP Code

Cell Phone #:*
Name of Cell Phone Provider*

Email Address - Please check your email regularly for important notices & account statements.*

Employment Status*
Va state licensing requires that we obtain your current employers address and phone # if you are currently employed.

Employed

Unemployed
Employer's Name:*

*
Employer's Physical Address (PO Box is not a valid address): City State ZIP Code

Employer's Phone #:*

2nd Parent Info
Relation to Child:*
2nd Parent:
*
Prefix First Last
Is the 2nd parent's physical address the same as the 1st parent?*

Yes

No. Please complete address information below.
*
Full Physical Address (PO Box is not a valid address): City State ZIP Code

Cell Phone #:*

Name of Cell Phone Provider*

Email Address - Please check your email regularly for important notices & account statements.*

Employment Status*
Va state licensing requires that we obtain your current employers address and phone # if you are currently employed.

Employed

Unemployed
Employer's Name:*

*
Employer's Physical Address (PO Box is not a valid address): City State ZIP Code

Employer's Phone #:*
Authorized Emergency Contacts:
MUST Provide 2 Emergency Contacts that live within 1 hr of child's location. CANNOT BE PARENT/GUARDIANS!

Prefix:*
1st Emergency Contact:*
1st Emergency Contact:

First Last
Relation to Child:*
Cell Phone #:*
Address:*
Full Physical Address (PO Box is not a valid address): City State ZIP Code

Prefix:*
2nd Emergency Contact:*
2nd Emergency Contact:

First Last
Relation to Child:*
Cell Phone #:*
Address:*
Full Physical Address (PO Box is not a valid address): City State ZIP Code

Parental Agreements:
BEHAVIORAL DISCLOSURE: The Adventure Club Team takes pride in providing a fun and safe environment for all of the children in our program. When parents, children, and The Adventure Club Team are all "on the same page" the children benefit immensely. Please refer to our Parent Handbook for further information.*
BEHAVIORAL DISCLOSURE: The Adventure Club Team takes pride in providing a fun and safe environment for all of the children in our program. When parents, children, and The Adventure Club Team are all "on the same page" the children benefit immensely. Please refer to our Parent Handbook for further information.
I agree and understand the steps The Adventure Club will take if my child does not adhere to these expectations.
Withdrawal Agreement*
WITHDRAWAL AGREEMENT: 1 week written notice of withdrawal MUST be submitted to TAC's main office via Seer message using the parent portal or an email at [email protected] or additional fees will apply.
I Agree to Submit a 1 Week Written Notice using my parent portal or email.
PARENT HANDBOOK: The Adventure Club reserves the right to make changes to any policy, procedure, tuition rates, fees, or other processes and information in this parent handbook, rate sheets, or our enrollment forms without prior notice. We reserve this right to maintain licensing compliance, stability, and integrity of the programs, and for the safety and security of the children & families enrolled in our programs, and for the staff that our company employs. A copy of our handbook can be found under "Parent Resources" on our website.*
PARENT HANDBOOK: The Adventure Club reserves the right to make changes to any policy, procedure, tuition rates, fees, or other processes and information in this parent handbook, rate sheets, or our enrollment forms without prior notice. We reserve this right to maintain licensing compliance, stability, and integrity of the programs, and for the safety and security of the children & families enrolled in our programs, and for the staff that our company employs. A copy of our handbook can be found under "Parent Resources" on our website.
I agree to review TAC's Parent Handbook
Parent Electronic Signature for Enrollment:*
First Last
Date Enrollment Submitted:*
MM slash DD slash YYYY

Payment Policies
VERY IMPORTANT ~ PLEASE READ THROUGH CAREFULLY

* NO-PAUSE TUITION ~ Services provided for school sites are retained per contractual agreements with MCPS, therefore tuition fees are charged continuously during each semester (both Fall & Spring).

* ADD-ON DAY FEES ~ Attendance on NON-SCHOOL DAYS of care requires an add-on day fee as outlined in our rate sheet and will be auto debited within 1 business day. ALL full days of care will be hosted at 77 Scattergood Drive in Christiansburg.

* UNPAID TUITION & LATE PAYMENTS ~ Payments can be made automatically using VISA, Mastercard, Discover, or American Express debit/credit cards (fee's applied for all digital transactions) or by a personal check (no fee applied) given to your child's Site Manager the THURSDAY prior to the week of attendance. Weekly tuition is processed each THURSDAY prior to week of attendance. If payment is returned for NSF, you will be charged a $35 processing fee. Payment in full will be expected no later than FRIDAY at 6 pm (including a $35 late fee) to avoid suspension of care until the balance is paid.

* LATE PICK-UP FEES ~ Any child clocked out of our system at 6:01pm or later WILL BE CHARGED A FEE, NO MATTER THE REASON FOR BEING LATE! (ie; vehicle breakdown, personal emergency, heavy traffic or car accidents, illness, working later than usual, etc.) Fees are as follows: $10 for the 1st 5 min's, and $1 a minute thereafter. Fees will be auto debited from your account.

Payment Frequency Options
Payments can be made automatically using VISA, Mastercard, Discover, or American Express debit/credit card (fee's applied for all digital transactions) or by a personal check (no fee applied) given to your child's Site Manager the THURSDAY prior to the week of attendance. Weekly tuition is processed each THURSDAY prior to week of attendance.
Non-School Day Care: If you only need care on NON-school days, choose "Non-School Day's Only" ($90/child/day)*

Non-School Day Care:
If you only need care on NON-school days, choose "Non-School Day's Only" ($90/child/day)

Weekly -- (NON-SCHOOL DAYS WILL BE HELD @ 77 SCATTERGOOD DRIVE IN CHRISTIANSBURG)

Non-School Day Care ONLY -- (DO NOT CHOOSE THIS IF YOU WANT A WEEKLY BILLING!)

DSS Assisted (Copay if any will be outlined by DSS) -- Parents are responsible for any weekly difference if there is one.
Payment Method Selection
How would you like to pay your tuition & fees?*
We accept: Visa, Mastercard, Discover, & American Express. Credit card processing fees will be added on to tuition - Our software does this automatically (processing fee of 3.4% + $0.50 cents per transaction), or Checking Account Withdrawal (ACH) (processing fee of 0.95 % + $0.25 cents per transaction.) -- ( Personal Checks are accepted with no additional fee -- during the school year checks may be give to your child's Site Manager each Thursday PRIOR to your child's attendance the following week )

Credit/Check Card

Checking Withdrawal (ACH)

Personal Check TURNED IN TO YOUR CHILD'S SITE MANAGER OR TAC OFFICE THURSDAY!
Name as it appears on the card or checking account:*
First Last
Billing Address:*
Billing Address City State Zip Code

Phone #:*
Email Address:*

Credit/Check Card #:*

CONFIRM Credit/Check Card #:*

Expiration Date:*

Please enter the month & year in the following format: mm/yyyy
3 digit security code on back of card:*

Name of Financial Institution:*

Routing Number:*

Checking Account Number:*

CONFIRM Checking Account Number:*

Debit Authorization Agreement
Charges that may be automatically debited from your credit card or checking account will include the following as applicable:

* Registration fees (billed upon enrollment each semester). (these fees are Non-Refundable)
* Weekly tuition charges.
* Credit Card - processing fee of 3.4% + $0.50 cents per transaction
* Debit Bank account (ACH) - processing fee of 0.95 % + $0.25 cents per transaction
* Late payment fee of $35.
* Add-On day fees for full days of care $45.
* Late pick-up fee per our policy (see parent handbook).
* Non-Sufficient Funds or Declined Payment fee of $35.
* Early Withdrawal Fee of $50 (min 1 wks written notice required).
* Approval for charges submitted via phone or email authorization.

Payment Agreement Confirmation
.*
By typing my name below, I acknowledge that I have read the payment policies in this agreement. I understand that I am responsible for all tuition & fees that I incur upon receipt of this enrollment and while my child is actively enrolled in TAC and I authorize TAC to debit due charges from my account information provided on this form. I understand that failure to comply with said payment policies could result in applicable late fees, suspension, and/or termination from the program.
Electronic Signature for Payment Agreement:*
First Last
If after clicking submit you remain on the same screen, please scroll back through the form to complete highlighted areas and resubmit.