Afterschool Registration Form

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Please complete this form for each student you will be registering for the Afterschool program.

1. Student Information

Student's Name *

Student Date of Birth *

年

月

日

Grade Level *

Transitional Kindergarten

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Sixth Grade

Seventh Grade

Eighth Grade

List any Allergies, Chronic Illnesses, or Medications *

Parent/Guardian information will be pulled from the Student Information System. This will include emergency contact, pick-up, and medical information. Is there any additional information you would like to add?

Yes

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