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After School Program-YGES
Information Document-If you are enrolling more than one child in ASP, complete a form for EACH child.
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* Indicates required question
Email
*
Your email
Student Name (Last, First Middle)
*
Your answer
Home Address
*
Your answer
Student Grade Level
*
Pre K
K
1
2
3
4
5
Homeroom Teacher (If Known)
Your answer
Father's Full Name
*
Your answer
Father's Phone Number
*
Your answer
Father's E-mail
*
Your answer
Mother's Full Name
*
Your answer
Mother's Phone Number
*
Your answer
Mother's E-mail
*
Your answer
If the child lives with someone other than the parent, please list name of person, relationship to child, and phone number.
Your answer
The following people other than those listed above may pick up my child from the after school program. Please include a valid phone number for each person listed.
*
Your answer
If school dismisses early because of weather or other reasons, please have my child:
*
Go home on their bus
I will arrange for pick-up
My child's bus number is:
Your answer
Special Instructions (allergies, medical, etc.) Please state "NONE" if your child does NOT have any medical or allergy issues.
*
Your answer
By typing my name below, I am verifying that I am the parent or guardian of this child.
*
Your answer
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