Open Hearth After School Kids at WES: (K-6) Registration Form 2023-2024

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Please complete this form to indicate your interest in having your child participate in the K- 6 after school program.
**Please note Kindergarten students may be placed in our PK/K program depending on enrollment, staffing, and the needs of individual students.

Completing this form does NOT automatically enroll you in the program. You will receive a confirmation letting you know when your child has been enrolled in our program. Families will be served on a first come, first served basis for sign ups.

Child's Full Name *

Grade *

Child's date of Birth *

YYYY

Address *

Please list others living in the home - names and ages of siblings, etc.

List two additional people who may be called in an emergency if the parents are unavailable . Please include full name, relationship, and phone number. *

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