Walton Elementary After School Program Waiver Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Dates: April - June 2024
Contact us at waltonactivities@gmail.com

Email *

Child's Name *

Phone Number *

Child's Homeroom Teacher and Classroom Number *

Division: 1 - Mrs. Rajwani / Mrs. Johnston - 4/5

Division: 2 - Mr. Finlay - 4/5 Mandarin

Division: 3 - Mr. Venegas / Ms. Grzesik - 4 / 5

Division: 4 - Ms. Ji - 4/5 Mandarin

Division: 5 - Mr. Parnell / Ms. Ewart - 4/5

Division: 6 - Ms. Hu - 4/5 Mandarin

Division: 7 - Ms. Meadows - 3/4

Division: 8 - Mrs. Sluis - 3 Mandarin

Division: 9 - Ms. Wegrich - 3/4

Division: 10 - Ms. Chen - 3 Mandarin

Division: 11 - Ms. Pham / Ms. Ariyawardena - 2/3

Division: 12 - Ms. Gosselin - 2 Mandarin

Division: 13 - Ms. Pobran / Ms. Ariyawardena - 1/2

Division: 14 - Ms. Hsiao - 2 Mandarin

Division: 15 - Ms. Mioch - 1/2

Division: 16 - Ms. Lore - 1 Mandarin

Division: 17 - Mrs. Hoang / Ms. Bordignon - 1/2

Division: 18 - Ms. Pan - 1 Mandarin

Division: 19 - Ms. Richmond - 1/2

Division: 20 - Ms. Thiara - K Mandarin

Division: 21 - Ms. Charles / Ms. Hwang - 1/2

Division: 22 - Ms. Zhang - K. Mandarin

Division: 23 - Ms. Biedka - K

Division: 25 - Mrs. Cimaglia / Ms. Peragine - K

Registered Program *

Crafting Club (K-2)

Robotics (K-2)

Ultimate/Cricket (K-2)

Painting & Drawing (K-2)

Freestyle Dance (K-2)

Soccer Corner (K-2)

Pottery (K-2)

Choir (K-5)

Modelling Clay (3-5)

Basketball 3-5

Clay & Craft 3-5

Chess Club 3-5

Math Club 3-5

Comic & Anime (3-5)

Ultimate/Cricket (3-5)

Required

Allergies & Medical Concerns (Below please list any allergies or medical concerns Walton After School Activity organizers and instructors should be aware of. Please be as detailed as possible.) *

Does participant have behaviour that we should be aware of? Kindly note that we won't be able to provide support staff as our vendors and volunteers are not trained as a support staff. If you would like to provide a support staff, please let us know via email to waltonactivities@gmail.com. All support staff may be subjected to criminal record check.
*

My Child has permission to walk home alone after their program *

Yes

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms