KIDS IN ACTION ASP 2021-2022 Form of Interest

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By completing the form below, you are requesting that your child/children be placed on the ASP waiting list. We are only accepting weekly registration at this time. Drop-in registration is not available. Please note that every elementary school does not house an ASP and some children are transferred to neighboring schools to attend the program. Thank you.

Child's School *

Child's Grade Level *

Child's Teacher *

Are there other siblings in the household that will need to attend ASP this year? *

Yes

If so, please list each additional child's name, teacher name and grade level.

Name of person completing this form. *

Relationship to child: *

Contact Information: (Please include phone number and email address) *

Submit

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