Richmond District After School Collab.

Richmond District After School Collab.   415-751-6600
741 30th Ave
San Francisco, CA 94121

Attendee: RDASC Registration 2016-2017

Please enter the following information:

* Student Name
* Parent/Guardian
School Site
* Address
* Grade entering as of August 2016
* Parent/Guardian Email Address
* Emergency Contact/Authorized Pick Up
* Relationship
* Emergency Contact Phone Number
* Additional Emergency Contact/Authorized Pick Up
* Relationship
* Emergency Contact Phone Number
Allergies: Please email specific instructions to
* Emotional, Behavioral or Special Needs
* Name of Student's Doctor/Phone Number/Address
* Name of Student's Dentist/Phone Number/Address
* Hospital Preference
* Insurance Provider & Insurance Coverage Number
In the event of a medical emergency I give my permission for my child to be taken and treated at an emergency facility/hospital.
I hearby give my permission to the physician selected by the director to hospitalize, secure treatment for, and to order injections, anesthesia or surgery for my child on this application.
*In the event of a medical emergency, I understand that the Richmond District After School Collaborative assumes no financial obligation for medical treatment. Agree
*Attendance Policy: Students are expected to attend RDASC Monday through Friday from 2:405:15pm (1:505:00pm at Lafayette). Your student can miss one day a week. Site Manager approval is required if missing more than one day/week on a consistent basis. Agree
*Late Pick Up Policy: Children must be picked up by the official closing time of 6pm. Regular pick up time is between 5:15pm and 6:00pm. After the third late pick up: Families who pick up their student(s) after 6:05pm will be charged $1/minute. Agree
*If your student is picked up early (before 5:30pm), you are required to fill out an SFUSD/ExCEL Early Release Form. Agree
*Please click here and review our policies relating to Parent/Guardian Permission Slip, Release Info, Student Behavior/Guidelines and Personal Rights. Agree

* Indicates required field




Richmond District Neighborhood Center