2022-2023 ASU GEAR UP After-school Activity Form

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Parents please complete this form if you would like to your child to participate in the 2022-2023 ASU-GU Afterschool activities. Students can sign up for multiple activities.

Eligible Montgomery Public Schools:

Baldwin Arts & Academics
Bellingrath Middle
Brewbaker Middle
Capitol Heights Middle
Carr Middle
Dunbar-Ramer
Floyd Middle
Goodwyn Middle
McKee Middle
Southlawn Middle

Full descriptions can be found at www.alasu.edu/gu-events

Email *

Project 2 Uplift

Students will participate in activities that will foster problem-solving/critical thinking skills, social emotional intelligence, effective communication, team building, technology, and workforce skills.

Dates/times vary/Onsite

Yes

Boys and Girls Club

Providing programs and opportunities which encourage young people, especially those who need us most, to maximize their potential and become caring, productive citizens of our community.

A PAPER APPLICATION IF ALSO REQUIRED. CONTACT YOUR SCHOOL SITE FACILITATOR.

Dates: Monday-Friday (3pm-8pm)

Location: Boys and Girls Club

Yes

Required

YMCA Achievers

The Achievers Gear Program is a seven-month learning experience designed to engage students in a standards-based curriculum and fun enrichment opportunities that will prepare youth for life beyond high school.

Dates: TBA

Location: TBA

Yes

Required

STUDENT INFORMATION

First Name *

Last Name *

Date of Birth *

YYYY

School Name *

Baldwin Arts & Academics

Bellingrath Middle

Brewbaker Middle

Capital Heights Middle

Carr Middle

Dunbar-Ramer

Floyd Middle

Goodwyn Middle

McKee Middle

Southlawn Middle

Grade Level *

7th grade

8th grade

Address *

City *

State *

Zip Code *

Student Cell Phone Number *

Sex *

Male

Female

Required

Race *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other:

Required

Shirt Size *

XXL

Other:

PARENT/GUARDIAN/EMERGENCY CONTACT INFORMATION

First Name *

Last Name *

Phone Number *

Email Address *

Alternate Phone Number *

Does the student have any allergies, chronic illness, or medical conditions? *

Yes

If yes, please describe in detail:

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