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The Homework House After school Program
The After school program is M-F from 3-6pm
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Email
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Your email
Child(ren) name
Your answer
*
Option 1
Parents name
Your answer
Parents address
Your answer
Parents email
Your answer
Parents phone
Your answer
Parent emergency contact name
Your answer
emergency contact address
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Emergency contact phone number
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emergency contact email
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2nd emergency contact name
Your answer
2nd emergency contact address
Your answer
2nd emergency phone
Your answer
2nd emergency email
Your answer
Medical Infor doctor name address phone and hospital affiliate
Your answer
Days of attendance
M-F 3-6pm
Monday
Tuesday
Wednesday
Thursday
Friday
Other:
Academic strengths
math
ELA
Art
music
dance
science
social studies
sports
robotics engineering
cooking
gardening
Other
Other:
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