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Boys & Girls Club of Hackensack
After School Program Sign Up 2020-2021 School Year
This form must be completed to be sent a registration packet.
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Email
*
Your email
Parent/Guardian Full Name
*
Your answer
Current Email Address
*
Your answer
Child(ren) Full Name (please list all kids separated by a comma)
*
Your answer
Cell Phone number for Call-Em-All System
*
Your answer
School Child Attends
*
Fairmount
Fanny Meyer Hillers
Jackson Avenue
Nellie K. Parker
Other:
My child(ren) are in the following grades (check all that apply)
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Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Required
Which Childcare option best fits your needs? If you wish to have multiple children with different options, please describe in "other."
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REMOTE LEARNING/SCHOOL DAY CHILDCARE: 7:45am - 3:00pm
AFTERSCHOOL PROGRAM : 3:00pm - 6:00pm
REMOTE LEARNING/SCHOOL DAY CHILDCARE + After school: 7:45am-6:00pm.
Required
Do you have the technology at home to print application, complete and send back?
*
Yes
NO
Would you prefer to pick up the application at the Club at designated times?
*
Yes
No
Are you a resident of the Hackensack Housing Authority ?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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