Capitol Heights Middle School 21st CCLC FREE After School Program Sign Up Form.
Please Note: This program is for 6th, 7th, and 8th grade students who attend CHMS. If you are registering more than one child, then please complete a separate form for each child.
The program will begin on the week of January 11th, 2021, will be from 2:30 until 4:30 from Monday through Thursday after school, and will run for 87 days. The first week of May will be our tentative schedule showcase.  
THIS FORM MUST BE COMPLETED BY THE CHILD'S PARENT/GUARDIAN.
Student Name *
Student Current Grade *
Student Date of Birth *
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My child is interested in the following enrichment activities: (You may choose more than one) *
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Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian Email *
Emergency Contact Person *
Emergency Contact Person Phone Number *
My child may be picked up by the following people:
By clicking on the check box, then I am electronically signing this form and agreeing to let my child participate in the Capitol Heights Middle School 21st CCLC after school enrichment program *
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