JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Boys & Girls Club of Lodi
After School Program Sign Up 2020-2021 School Year
This form must be completed to be sent a registration packet.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
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
*
Washington School
Wilson School
Columbus School
Hilltop School
Roosvelt School
Bergen Charter
Other:
My child(ren) are in the following grades (check all that apply)
*
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."
*
REMOTE LEARNING/SCHOOL DAY CHILDCARE: 8:05am - 3:05pm
AFTERSCHOOL PROGRAM : 3:05pm - 6:05pm
REMOTE LEARNING/SCHOOL DAY CHILDCARE + After school: 8:05am-6:05pm.
Other:
Required
Do you need Early Drop off Option?
*
I need early drop off at 7:30am
I do not need early drop off
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
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Boys & Girls Clubs of Lower Bergen County.
Report Abuse
Forms
