GWT Extended Day Application

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Please do not include payment until your child is notified that they have been registered. We will accept our previous students first and then accept new students. ***We will have limited availability due to safety precautions.

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Child's Name *

Date of Birth *

Age *

Grade *

Teacher *

Guardian #1 Name *

Guardian #1 Address

Guardian #1 Phone Number *

Guardian #2 Name *

Guardian #2 Address *

Guardian #2 Number *

Medical Information *

My child has a medical condition, concern, or allergy.

My child has no medical conditions.

Pakollinen

My child has medicine kept at school *

Yes

Pakollinen

Physicians Name *

Physician's Phone Number *

If your child has a medical condition, allergy or concern, please describe below. *

If your child has medicine stored at school, please list below.

In case of Emergency, contact: ( Include name and number) *

My child may be released to the following: *

My child may be released to the following:

I have read and agree to follow the rules, payment plan and guidelines of the GWT Extended Day Program. Please type your name below. *

Lähetä

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