Ladysmith Elementary School After School Program Registration
The Ladysmith Elementary School will once again be offering its Early Risers and After School Program starting October 7, 2019.  The Early Risers Program will run from 7:25-8:10 am Monday thru Thursdays and the After School Program will run from 3:45-5:45 pm Monday thru Thursday.  If you have questions on the program of this registration form please contact the program director, Kirk Yudes, by email at KYudes@sdlwi.org
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Email *
Last Name *
First Name *
Date of Birth *
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DD
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Gender *
Ethnicity *
Primary Language *
Complete Address *
Phone *
Parent Email *
School *
Grade *
Homeroom Teacher *
Math Teacher *
Literacy(English) Teacher *
Student Resides with *
Transportation Home *
Special Needs (Allergies, Medications, Diet, etc.) *
Parent/Guardian Last Name, First Name (If Multiple Please list All) *
Parent/Guardian Home Phone *
Parent/Guardian Work Phone *
Relationship to Student *
Please List Emergency Contact Last Name, First Name and Relationship to the student *
Emergency Contact Address *
Emergency Contact Home Phone *
Emergency Contact Work Phone *
List Any Authorized People who can pick up your student followed by their phone number please: *
Please List anyone NOT authorized to pick up your student(s) Last Name, First Name:
Electronic Signature certifying that you certify that you have read and do understand the above information: *
A copy of your responses will be emailed to the address you provided.
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