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IGNITE Before & After School Program Registration 2019-2020
If you have more than one scholar, please complete a separate form for each scholar.
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* Indicates required question
Which program will your scholar be participating in:
*
Monday - Friday Program (5 days/week)
Tuesday & Thursday Program (2 days/week)
Early Care Program (5 days/week)
Required
Scholar Name:
*
Your answer
Scholar Address:
*
Your answer
City:
*
Your answer
State:
*
Your answer
Zip Code:
*
Your answer
Parent/Guardian's Name:
*
Your answer
Parent/Guardian's Address:
*
If different from the scholar's address listed above
Your answer
Parent/Guardian's Preferred Phone Number:
*
Your answer
Scholar's Grade:
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Scholar's Homeroom Teacher:
Your answer
Preferred Email Address:
*
Your answer
Emergency Contact:
*
Your answer
Emergency Contact's Phone Number:
*
Your answer
Emergency Contact's Relationship to Child:
*
Your answer
ALL Persons Authorized to Pick-Up Scholars (other than parent/guardian listed above):
*
Please include all names, phone numbers and relationship with the child. Photo ID will be required for pick-up.
Your answer
Please list any allergies and/or health or medical concerns that IGNITE staff should be aware of:
*
If there are no concerns, answer with none.
Your answer
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