Before & After School Enrollment

Adventure Club Fall 2024-25 Enrollment

"*" indicates required fields

Welcome to The Adventure Club Before & After School Program!

Please complete this form to its entirety. All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

In order to attend children must be 5-10 years old.

Please review our 2024-25 Rates below:

2024-25 Rate Sheet

Falling Branch Elementary is transported by Adventure Club Vans — Christiansburg Primary & Christiansburg Elementary are transported by MCPS bus.

PARENTS/GUARDIANS are required to setup a form of payment upon invitation to our tuition software. You will receive an invitation to brightwheel with any additional instructions once enrollment has been processed. All registration fees are due once your brightwheel account has been setup.

Childcare Assistance Information:

Childcare Payment Assistance ~ Please chooce 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. NOTE: 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

Pulaski County

Radford City

Giles County

Other – county is not listed above

Other county you are receiving assistance from:*

DSS Subsidy Policy*
Acknowledgement: I have read and will abide by the policies listed above.
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.

Child Information:

Is your child currently enrolled in our Adventure Club program?*
If your child is currently enrolled at The Adventure Club and none of your information has changed, we can use what we have on file for your medical information, medical consents, and emergency contact information.

Please select one of the options below:

REQUIRED DOCUMENTS – NEW FAMILIES ONLY!

Drop files here or

Max. file size: 100 MB.

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)

How many children are you registering?*

Do you plan to attend during Winter or Spring Break? (Reservation)*
Weekly families have priority for reservation. There are limited spaces! Spring Break Rate: $195 per week (5% sibling discount).
During this time regular tuition is not active. In order to attend during the break you must reserve.
Spring Break (March 10th – 14th)

Please select one of the options below:

1st Child Information:

1st Child:*
1st Child:
Gender First “Nickname” Last

Date of Birth:*
Month
Day
Year

1st Child's School Attending:*

Christiansburg Primary

Christiansburg Elementary

Falling Branch Elementary

Non-School Day’s Only

1st Child's Start Date:*
MM slash DD slash YYYY

1st Child's Program:*

Before School

After School

Before & After School

Non-School Day’s Only

Flex Care Hourly
Weekly tuition does not pause during the school semester and is not based on your child’s attendance.

2nd Child Information:

2nd Child:*
2nd Child:
Gender First “Nickname” Last

Date of Birth:*
Month
Day
Year

2nd Child School Attending:*

Christiansburg Primary

Christiansburg Elementary

Falling Branch Elementary

Non-School Day’s Only

2nd Child's Start Date:*
MM slash DD slash YYYY

2nd Child's Program:*

Before School

After School

Before & After School

Non-School Day’s Only

Flex Care Hourly
Weekly tuition does not pause during the school semester and is not based on your child’s attendance.

3rd Child Information:

3rd Child:*
3rd Child:
Gender First “Nickname” Last

Date of Birth:*
Month
Day
Year

3rd Child School Attending:*

Christiansburg Primary

Christiansburg Elementary

Falling Branch Elementary

Non-School Day’s Only

3rd Child's Start Date:*
MM slash DD slash YYYY

3rd Child's Program:*

Before School

After School

Before & After School

Non-School Day’s Only

Flex Care Hourly
Weekly tuition does not pause during the school semester and is not based on your child’s attendance.

4th Child Information:

4th Child:*
4th Child:
Gender First “Nickname” Last

Date of Birth:*
Month
Day
Year

4th Child School Attending:*

Christiansburg Primary

Christiansburg Elementary

Falling Branch Elementary

Non-School Day’s Only

4th Child's Start Date:*
MM slash DD slash YYYY

4th Child's Program:*

Before School

After School

Before & After School

Non-School Day’s Only

Flex Care Hourly
Weekly tuition does not pause during the school semester and is not based on your child’s attendance.

Medical Information & Consents:

*I have chosen to use my current Medical Information & Consents listed in my file at The Adventure Club*

Photo Consent*
Photo’s:
Photos are reviewed prior to posting on Facebook to ensure proper exposure. TAC WILL NEVER publicly post children’s names without parental consent!

I Agree to allow photos of my child

I DO NOT allow photo’s of my child

Pediatrician's Name:*

Pediatrician's Phone #:*

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.

Hospital Preference:*

Allergies or Special Needs*
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)

Specific Instructions for Emergency Medical Care & Hospital Transport:

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

Drop files here or

Max. file size: 100 MB.

Parent/Guardian Information:

Who does the child live with?:*

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

Name*
First Last

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

Cell Phone #*

Email*

Employment Status*

Employed

Unemployed

Employer's Name:*

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

Employer's Phone #:*

Relation to Child:*
2nd Parent

Name*
First Last

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

Yes.

No. Please complete address information below.

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

Cell Phone #:*

Email*

Employment Status*

Employed

Unemployed

Employer's Name:*

Address*
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!

Authorized Emergency Contacts:

* I have chosen to use my current Emergency Contacts listed in my file at The Adventure Club*

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

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*
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.
What happens when a child is misbehaving? What happens when a child exhibits unwanted behavior? The following are a list of steps that our staff takes:
Step #1: Inform another staff member of what has happened so you may devote more time to problem solving with the child.
Step #2: Have the child “cool off” in an area away from the other children. Inform the child that after a few cool down minutes they should raise their hand when they are ready to talk about what happened.
Step #3: Listen to the child and problem solve.

If the child WILL NOT comply with a physical task:
Step #4: If the child continues defiance and the Adventure Club Team have exhausted all options, the staff will call the parent.
I agree and understand the steps The Adventure Club will take if my child does not adhere to these expectations.

COMMUNITY PLAY RELEASE & HOLD HARMLESS AGREEMENT:*
COMMUNITY PLAY RELEASE & HOLD HARMLESS AGREEMENT:
I understand that my child will not be allowed to play on any equipment unless my child meets the height and weight requirements. I acknowledge, release, and hold harmless the facilities, personnel, and property of Adventure Club from a possible injury that could occur while my child is playing on the play equipment. I release and hold harmless The Adventure Club, and employees from liabilities and claims arising from my child’s participation on play equipment. I give my permission to allow my child(ren) to play on the equipment and acknowledge the risk associated with play.
I agree to the above agreement.
I do NOT agree to the above agreement. By selecting NO, I understand my child will NOT be allowed to play on play equipment.

Parental Agreements:

* I have chosen to continue to use my current answers for Parental Agreements listed in my file at The Adventure Club*

Payment Method Selection

Which Tuition Type?*
We accept: ALL major credit cards. Credit card processing fees will be added on to tuition – Our software does this automatically (processing fee of 2.95% per transaction), or Checking Account Withdrawal (processing fee 0.6% per transaction.) Tuition runs the Thursday PRIOR to your child’s attendance the following week).

Flex Care will be billed by the minute at $8/hour ran weekly on Friday.

ALL PAYMENTS MUST BE SETUP BY PARENTS/GUARDIANS UPON INVITATION TO BRIGHTWHEEL IN ORDER TO COMPLETE REGISTRATION! No Checks or cash accepted.

Flex Care $8 per hour

Weekly

Non-School Day’s Only (Billed as attended)

Debit Authorization Agreement

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

* Registration Fee’s. (these fees are Non-Refundable)
* Weekly Tuition
* Flex Care Hourly – processed daily following attendance by the minute.
* Winter & Spring Break Tuition (if reserved)
* Non School Day’s
* Non-Sufficient Funds or Declined Payment fee of $35.
* Late Payment fee of $35.
* Late pick-up fees. ($5.00 flat fee after 5 minutes and $1.00 per minute after that)
* Approval for charges submitted via phone or email authorization.

Payment Agreement Confirmation

Fee Acknowledgement*
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 fees that I incur upon receipt of this pre-registration and while my child attending, I authorize TAC to debit due charges from my account information provided in brightwheel. I understand that failure to comply with said payment policies and or lack of setup of billing information could result in applicable late fees and/or denied entry from future events.

Electronic Signature:*
First Last

Date Registration Submitted:*
MM slash DD slash YYYY

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