Check the boxes of any of the programs you are interested in. All programs run after school until 4:15pm. A snack is provided. *
Required
How will your student get home? *
Does your student typically ride a shuttle bus on this day?
Clear selection
Parent/Guardian Name *
Your answer
Best Phone Contact *
Your answer
Please write down anything the instructor needs to know about your child and their safety
Your answer
Does your child have any allergies? If so, what
Your answer
If selected for an after school program you will receive a DoJo message confiriming your student's spot. Please respond to the DoJo message to confirm their spot. If you do not receive a DoJo message, they did not get into a program this session. *
Pickup is promptly at 4:15. After being late two times your student will be removed from the program. Do you agree to what you have read above? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Deer Park Community City School District. Report Abuse