After School Program Registration Form May-June 2023
Please complete this form to complete your registration for the after-school program this school year. The Emergency Care Week or any afternoon after-school. Currently, you will need to fill out one form for each child that is registered. 
The program is set to begin Monday, May 15, 2023, until June 30, 2023
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Email *
Child's First Name
 *
Child's Last Name
Child's Birthdate
MM
/
DD
/
YYYY
Parent First Name(s) *
Parent's Last Name
Street Address *
City *
Postal Code *
Phone Number *
Other numbers that can be used to reach a parent in case of emergency.
Days your child will be attending.  The "other" option is for schedules that change weekly.  Please indicate a probable number of days per week your child will attend.
 *
Required
Email address *
Emergency Contact #1 *
This person is contacted in the event that both parents are unavailable.  
Person's relation to the child
 *
Emergency Contact #1 phone number *
Emergency Contact #2 *
This person is contacted in the event that both parents and the emergency contact #1 are unavailable.  
Person's relation to the child
 *
Emergency Contact #2 phone number *
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