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CLC/After School Registration
Please fill out 1 FORM FOR EACH STUDENT you are registering for the After School Program
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* Indicates required question
Email
*
Your email
Student's Name:
*
Your answer
Student's Grade
*
Your answer
Any know allergies or special modifications needed?
Your answer
Elementary Classroom Teacher or MS or HS
*
Your answer
Program(s) your student will attend
*
4K-1st Gr: PALs CLC (M-F, beginning 9/3)
2-6th Gr: LEAP CLC (M-F, beginning 9/3)
7-12th Gr: 1st Street (M-F, beginning 9/3)
5-12th Gr: Open Library (M-F, beginning 9/3)
3-6th Gr: Girls Who Code (Tues, beginning 9/10)
7-12th Gr: Girls Who Code (Th, beginning 9/12)
5-12th Gr: Art Club (Wed, beginning 9/11)
Required
Parent/Guardian Name
*
Your answer
Phone Number
*
Your answer
Will your child ride the Late bus
*
Yes
No
If you child will use the late bus, please indicate the primary drop off address here. Include any special bus notes:
Your answer
Emergency contact/Authorized pick up name and phone number
*
Your answer
Any Additional authorized pick up names and phone numbers:
*
Your answer
Days we should expect your child at the after school program
*
Monday
Tuesday
Wednesday
Thursday
Friday
Irregular Schedule
Required
Irregular schedule notes:
Your answer
Anything else the After School Staff should know about your child?
Your answer
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