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City of Huntsville

308 Fountain Circle Southwest, Huntsville, AL, 35801, US


After-School Program Registration


Date of Birth

Parent/Guardian Name(s)

Emergency Contact (other than parents) 


Please List Who Is Authorized To Pick Up Your Child

Authorized Person One

Full Name

Authorized Person Two (optional) 

Full Name

Authorized Person Three (optional) 

Full Name

Is your child under a doctor's care or taking medication?

By signing below I am agreeing to the following:

Medical Treatment: As a parent or legal guardian of the above-named participant, I hereby give my consent for emergency medical care prescribed by a licensed Doctor of Medicine, Doctor of Dentistry or Emergency Medical Technician/Paramedic. This care may be given under whatever conditions are necessary to preserve life, limb or well-being of my dependent.

Behavior: As a parent or legal guardian of the above-named participant, I understand that my dependent may be dismissed from the program for disciplinary reasons at any time without recourse or refund.

Damages: In consideration of you accepting my child’s entry, I hereby, for myself, my child, my heirs, executors and administrators, waiver and release all rights and claims for damages I or my child may have against the City of Huntsville and its representatives, successors and assigns for any and all injuries suffered by myself or my child at any activity sponsored by the City of Huntsville Parks and Recreation Department.

Photo Release: I hereby authorize the City of Huntsville, Alabama to publish and use my child’s name and/or my child’s likeness (“Likeness”) for the promotion publicity, advertising, or other manner or media by the City of Huntsville (the “City”) Department of Parks and Recreation or any other representative authorized to act on behalf of the City. A full copy of the waiver can be obtained at the recreation center’s front desk.

Fees: $20 per student per week, $10 for each additional child. Payment may be made weekly. First payment must be received before start date.

Code of Conduct:

  • No weapons allowed on the property
  • No profanity or fighting is allowed (seek staff for intervention)
  • No using or possession of tobacco products, vapes, or alcoholic beverages
  • No vandalism of property  
  • No running in the hallways
  • No sagging pants
  • No hats or bandannas inside the facility
  • No food, drinks, or candy in gyms or computer labs
  • Do not leave the facility unless you are with staff or your parent/guardian

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