JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
BASC Survey for 2020-2021 School Year
Student Last Name
Your answer
Student First Name
Your answer
Grade
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Clear selection
Age of Student
Your answer
Please share any information about your child that would be helpful for us in our planning process
Your answer
Elementary School Attending
Choose
Bethlehem Elementary
Ellendale Elementary
Hiddenite Elementary
Stony Point Elementary
Sugar Loaf Elementary
Taylorsville Elementary
Wittenburg Elementary
Parent/Guardian Name
Your answer
Relationship to Child
Your answer
Parent/Guardian Phone Number
Your answer
Parent/Guardian Email
Your answer
Did your child attend BASC during the 2019-2020 school year?
Yes
No
Will you need childcare for the 2020-2021 school year?
Yes
No
Please indicate when you will need care.
AM Care
PM Care
Both AM and PM care
Will your child attend school on the A schedule (Mon & Tues) or the B schedule (Thurs & Fri)?
A Schedule
B Schedule
Will you have a working phone number and a secondary contact number in the event your child becomes ill while in our care?
Yes
No
I understand that the BASC program will follow the same guidelines as the regular school day regarding social distancing, the wearing of masks, handwashing and other guidelines deemed necessary for the health and safety of students and staff.
Yes
No
Do you want to be emailed an enrollment form for childcare so you can register now paying the $25.00 registration fee? The enrollment form can be dropped off at your school or it can be mailed.
Yes, email me the enrollment form and I will return via mail.
Yes, email me the enrollment form and I will drop it off at my school site.
No, I will register on August 10th by enrolling at my school site from 2-5 pm at the BASC site.
If you have any questions or need additional information, you may email
smiller@alexander.k12.nc.us
You may also contact the office at your school to get contact information for your site coordinator if needed. This is not an enrollment form. Students who were enrolled last year in the BASC program will get priority. The enrollment form is required to enroll your child.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Alexander County Schools.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
Sign in to continue
Cancel
sign in
To fill out this form, you must be signed in. Your identity will remain anonymous.
Report Abuse
Cancel
sign in
