2017-2018
Milk Drop Club


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Registrant Fee: $0.00



Billing information


Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*EDGERTONEXPLORITCENT 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

Applicant Signature
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Registration inquiries:
Mary Molliconi
mary@edgerton.org
(402) 694-4032


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Student Information

Program Information
 
Payment Schedule:
# of students             Member fee weekly/in full 10% discount     Non-member fee weekly/in full 10% discount
1                               $15 / $450                                                  $25 / $787
2                               $25 / $787                                                  $35 / $1,225
3 or more                  $35 / $1,225                                               $45 / $1,418
   
Even those applying for Scholarship will be required to put down the $50 deposite.  That can be refunded after the start of school.  If you have a financial hardship and can not pay the deposit, please contact Mary Molliconi.   
Parent Information
Membership 
Edgerton Explorit Center Terms, Conditions, and Release of Liability Agreement

I, the undersigned, parent or guardian of the child(ren) named above do hereby consent his/her/their participation in the Edgerton Explorit Center Afterschool Program. I acknowledge that participation in the program may expose the above named student(s) to possible injury. I agree to waive and release the Edgerton Explorit Center from all claims of damages that may arise. I authorize the Edgerton Explorit Center and other organizations affiliated with their Afterschool Program to use photographs of my child(ren) on Facebook, their website, promotional brochures and at the center.

I also give permission to transport or walk my child(ren) to special events adnd field trips off site during the Afterschool Program. I acknowledge that my child(ren) is expected to behave in an appropriate and respectful manner and particiate in all activities. If inappropriate behavior issues are consistent, my child(ren) will be asked to take a break from the program until the problems have been addressed, corrected and resolved.
Check this box to indicate that you have read and agree to all of the above terms & conditions