Sullivan School 21st CCLC Extended Day Program

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Sullivan School 21st CCLC Extended Day Program - Winter Session 2022

The program begins January 18th and ends March 10th.
Program days: Monday through Thursday from 2:15 pm - 4:45 pm
Daily Schedule
2:15 - 2:45 Homework & Snack
2:35 - 3:45 Activity #1
3:45 - 4:45. Activity #2
4:45 Dismissal
There will be no Afterschool Program on early release days

Email *

First name *

LAST NAME *

Grade *

Homeroom *

Parent Name *

Emergency contact cell number *

Bus Transportation is NOT available at this time. *

I will pick up my child at 4:45

My child has permission to walk home at 4:45

I give my child permission to participate in the below listed activities offered through the Lowell Public Schools Extended Time Program. Permission is also granted for my child to travel on trips for special programs that are offered through the Lowell Public Schools Extended Time Program.
The Lowell Public Schools Extended Time Program is not responsible for any injury or accident that may occur during the above listed course/program(s) or due to the falsification of any information provided on this form.
I give permission for emergency medical treatment to be administered to my child by qualified medical personnel in the event of an accident or injury.
I give permission for my child to be videotaped and/or audio taped during participation in the above listed course/program(s) conducted by the Lowell Public Schools Extended Time Program. I understand that the footage (pictures, video and sound) may be incorporated into materials that promote the Lowell Public Schools Extended Time Program.
I give permission for my child to attend the 21st Century program at the Sullivan School, AND I will be responsible to pick up my child at 4:45pm.

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