MS/HS Extended Day Permission Fall '24
The extended day program is back and begins in January. This form is for you to complete if your student wishes to participate in any of the program activities. Activities run from 2:30 pm-4:30 pm Monday-Thursday when school is in session, unless otherwise noted. Snacks are provided. Transportation is provided for on site programs for students who typically ride the bus. There is NO program on half days, early release days or the days before a long weekend. The first day of the program offerings are 10/07/24 and run until 01/17/25, but some dates, and times, will vary by specific club (these dates are noted below). If students sign up for one of these clubs, they are welcome to sign up for another club for the remainder of the session.

If you have any questions, please feel free to reach out. You can contact me via email at shorton@southseneca.org.
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Email *
Student Last Name: *
Student First Name: *
Student Grade: *
Are there any known food/medical allergies or other conditions we should be aware of? If so, please list:
Monday *note specific dates. Students may sign up for more than one club as they run different dates*:
Tuesday:
Wednesday:
Thursday:
Bus to address:
Bus will provide transportation to this alternative address:
On what days will the alternative address be used?
Walker (If a student walks to and from school, they are considered a walker for the after school program.)
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Parent/Designee will pick up:
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1st Approved Pick Up/Emergency Contact & Phone Number:
2nd Approved Pick Up/Emergency Contact & Phone Number:
3rd Approved Pick Up/Emergency Contact & Phone Number:
Parent/Guardian Name: *
Parent/Guardian Phone Number:
 *
I give my child, named above, permission to participate in the after school program. I will make a reasonable effort to notify Mrs. Horton of any absences or adjustments. Additionally, he/she will sign out with Mrs. Denmark or Ms. Nelson if not staying for the program. Parent Pick ups - Supervision is over at 4:30. If a student is not picked up on time, they will wait at the Transportation building. If this becomes a pattern, administration will contact the family. The transportation arrangement listed will be adhered to. 
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