2022/2023 EUSD Before/After School Waitlist Form

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Hello Evergreen Families!

Currently, our Before/After School Program sites are currently full. In order to be added to the waitlist, please fill out the form below. you will be contacted when/if a spot becomes available.

Our program is offered at 3 locations:
Bend Elementary School: Room 6 (530-527-4648, extension 7406)
Evergreen Elementary School: Room 30 (530-347-3411, extension 7230)
Evergreen Middle School: Room 72 (530-347-3411, extension 7372)

Fees:

A one-time non-refundable enrollment fee of $20.00 per student is required; this will be submitted with the final enrollment forms prior to the start of the school year. Enrollment fees are non-refundable.

Bend, Evergreen Elementary, & Evergreen Middle School Monthly Before/After School Program Fees per child:
Before School Program - $40.00/month
After School One Hour Program (TK-3 Only) - $40.00/month
Full After School Program (TK-3) - $100.00/month
Full After School Program (4-8) - $75.00/month

Email *

Please complete one waitlist form, per student you are enrolling.

Student's First Name *

Student's Last Name *

Student's Date of Birth *

YYYY

School Site Selection: *

Program Selection: *

Before School Program ($40.00/month)

After School One Hour Program TK-3 Grade Only ($40.00/month)

Full After School TK-3 Program ($100.00/month)

Full After School 4th-8th Grade Program ($75.00/month)

Required

Student's Grade Level in August 2022 *

Student's Address, City, Zip Code *

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