Register for the After-School Program

Student information

Tell us about the student joining the program. All fields are required unless marked optional.

First name

Middle name (optional)

Last name

Grade for 2026–27

Gender

Male Female

Allergies (optional)

List food, medicine, or environmental allergies. Leave blank if none.

Parent or guardian

The adult responsible for this registration and for payment.

First name

Last name

Middle initial (optional)

Home address

Street, city, state, and ZIP.

Cell phone

Home phone (optional)

Work phone (optional)

Emergency contacts

People we can call if we can't reach you, in the order we should try them.

First contact

Full name

Relationship to student

For example: grandmother, uncle, neighbor.

Phone

Second contact (optional)

Full name

Relationship to student

Phone

Pick-up

Other adult allowed to pick up (optional)

Staff will ask for photo ID from anyone not listed on this form.

Policies and signature

Read the program policies, then sign by typing your full name.

Costs

Deposit: $20 per child, non-refundable, paid at the front office
Daily rate: $10 per day
Late pick-up: $5 for every minute after closing

Hours

Mon–Thu: 3:30 to 6:00 PM
Fri and early release: 12:00 to 3:00 PM

Rules

If a child is not picked up and staff have not heard from a parent or guardian, Horry County law enforcement will be contacted about child abandonment.
Participation is paused when a balance goes over $50 or fees stay unpaid for two billing cycles, until the account is paid in full.
Ongoing behavior issues or repeated nonpayment may lead to required prepayment or referral to collections.
Enrollment is capped at 38 students, first come, first served, after staff and returning families. Once full, new registrations join a waitlist.

I have read and accept the Bridgewater Academy After-School Program policies.

Signature: type your full name

Date

Typing your name counts as your electronic signature. Pay the $20 deposit separately at the front office by cash, check, or MyPaymentsPlus.

After-School Program registration

Student information

Parent or guardian

Emergency contacts

Policies and signature

Costs

Hours

Rules

Next step