TASC Registration 2025-26

Parent/Guardian Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Parent/Guardian Cell Phone

Parent/Guardian Address

Street address

Apartment / suite number

Country

City

State

State/Province

ZIP / Postal Code

Registration

Enrollee Information

Teen First Name

Teen Last Name

Teen Email

Teen Cell Phone (or best # to reach)

Teen Birth Year

Grade This Fall

Teen Pronouns

Other Pronouns:

Please list any other pertinent medical information (food or medication allergies). Enter "NA" if not applicable:

Please let us know about your teen's learning needs, including any IEP or 504 plans that are in place for your teen. This information will help TASC better meet the needs of your teen.

Is the teen allowed to leave on their own?

Medical Consent and Emergency Information

Emergency Contact

It is important that we have an emergency contact if a parent can't be reached.

Emergency Contact: First Name

Emergency Contact: Last Name

Emergency Contact: Relationship to Teen

If Other, please specify the type of relationship:

Emergency Contact: Phone Number

Permissions

I hereby give permission to the staff of the Boston Workers Circle to administer basic first aid and/or CPR to my teen and/or take my teen, to a hospital for medical treatment when I cannot be reached or when delay would be dangerous to my teen's health. I agree to pay for any expenses incurred.

Parent/Guardian Signature

Parent/Guardian Signature Date

Are you enrolling a second teen?

YesNo

Additional Enrollee

Teen First Name

Teen Last Name

Teen Email

Teen Cell Phone (or best # to reach)

Teen Birth Year

Grade This Fall

Teen Pronouns

Other Pronouns

Please list any other pertinent medical information (food or medication allergies). Enter "NA" if not applicable:

Please let us know about your teen's learning needs, including any IEP or 504 plans that are in place for your teen. This information will help TASC better meet the needs of your teen.

Is the teen allowed to leave on their own?

Medical Consent and Emergency Information

Emergency Contact

It is important that we have an emergency contact if a parent can't be reached.

Emergency Contact: First Name

Emergency Contact: Last Name

Emergency Contact: Relationship to Teen

If Other, please specify the type of relationship:

Emergency Contact: Phone Number

Permissions

Parent/Guardian Signature

Parent/Guardian Signature Date

Payment

Choose the appropriate tuition rate for your family below. Cost should never be a barrier to accessing BWC programs. Email info@circleboston.org if you'd like a payment plan or tuition assistance.

BWC Membership is required for TASC families: If you haven't already renewed for 2025-26, please renew membership after completing this form.

Tuition - Per Person - Please select your rate

Higher Income - $475Moderate Income - $400Limited Income - $375Other

Other Tuition Amount

Subtotal

Would you like to increase your payment to help cover the credit card transaction fee?

YesNo

Total

Tuition Only Total

Credit Card Information

Name on Card

Billing Email

Billing ZIP Code

Credit Card Number

CVV

Expiration Month (MM)

Expiration Year (YYYY)