JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
University School Afterschool Registration 23-24
Please complete one form for each child planning to attend afterschool care.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Grade Level for 2023-24 School Year
*
Choose
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Home Address
*
Your answer
Parent/Guardian #1
Name
*
Your answer
Parent/Guardian #1
Cell Phone
*
Your answer
Paren Guardian #1
Email address
*
Your answer
Parent/Guardian #2
Name
Your answer
Parent/Guardian #2
Cell Phone
Your answer
Parent/Guardian #2
Email Address
Your answer
Emergency Contact #1 (other than guardians)
Name
*
Your answer
Emergency Contact #1 (other than guardians)
Phone Number
*
Your answer
Emergency Contact #1 (other than guardians)
Relationship to Student
*
Your answer
Emergency Contact #2 (other than guardians)
Name
Your answer
Emergency Contact #2 (other than guardians)
Phone Number
Your answer
Emergency Contact #2 (other than guardians)
Relationship to Student
Your answer
Pick-up list (child cannot leave the program without written permission or phone call from guardian. Picture ID will be checked)
Your answer
Health Concerns: (Please list any medical, physical, behavioral, emotional, or other needs)
Your answer
Allergies
Your answer
Registration Information-Please list the days you plan to enroll your child. You will only be charged for the days that your child attends afterschool.
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of East Tennessee State University.
Report Abuse
Forms
