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After School Program Registration
Event Timing: November 4th-April 30th, 2021
Event Address: Hybrid Online and 2230 Leffingwell HTX 77026
Contact us at (713) 319-5708 or
DistrictBeeUrbanFarm@gmail.com
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Email
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Name
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Email
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Phone Number
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Are you allowed to participate in Recreational Activities?
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Health Information - Please List Medication, Allergies, and/or Health Problems
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Please Provide Parent/Guardian Information- Include Name, Address, Contact Number, Email
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Please Provide Emergency Contact Information- Include Name, Address, Contact Number, Email
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Child(ren) will only be released to a parent or a person designated by the parent/guardian after verification of ID. I hereby authorize the program to allow my child(ren) to leave ONLY with the person listed below. Please list the name and phone number for each person.
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