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DSA After Care Program
Registration Form: Please complete a SEPARATE form for each child you are registering. If you have any questions, please reach out to
aftercare@deltasteamacademy.org
. Thank you!
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Email
*
Your email
Barring illness or something similarly unexpected, do you intend for your child to attend aftercare 3 days or more each week?
*
Yes
No
Child's Last Name:
*
Your answer
Child's First Name:
*
Your answer
Parent(s) Name(s)
*
Your answer
Parent Contact Phone Number(s)
*
Your answer
Parent Email Address(es)
Your answer
Please list the names, phone numbers, and relationship of all adults authorized to pick up your child(ren). (e.g. Janet Johnson 404-555-1234 Aunt):
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Your answer
Please list all known allergies:
*
Your answer
I have read and reviewed the contents of the DSA aftercare program Parent’s Manual, and I agree to adhere to all policies and procedures of the Aftercare Program. Please type your full name which will serve as your electronic signature.
*
Your answer
A copy of your responses will be emailed to the address you provided.
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