2020-2021 WIN Registration
This form will be used to register your student for the WIN After School Program. Spaces will be filled in the order that the registration forms are received. If your student is placed on the waitlist, you will receive a phone call.

Responses will guide us in the hiring, space, and supplies needs for the program.

https://drive.google.com/file/d/1OpA1JNMJdSdQD-TG8mGl_ETepTNiuxsU/view?usp=sharing

https://drive.google.com/file/d/1wYuTaeqTZIIsc58dtqYHsVYv0a_nzcUC/view?usp=sharing
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Email *
Student's First Name *
Student's Last Name *
Student's Gender *
Student's Race *
 Which school does your student attend? *
What grade is your student in? *
Parent/Guardian 1 Name *
Parent/Guardian 1 valid Email *
Parent/Guardian 1 Phone Number *
Parent/Guardian 2 Name
Parent/Guardian 2 Email
Parent/Guardian 2 Phone Number
Please select the days that you would like your student to attend (this is based on 5 days of in person learning) *
Required
After WIN, my student will: *
If a student is to walk/bike home what time should he/she leave? *
Required
If a student is to be picked up by an adult (16+) which of these times would be the closest? *
Required
Please list adults that have permission to pick up your student. They will be asked to provide a photo ID
Emergency Contact 1 Name
Emergency Contact 1 Phone Number
Emergency Contact 2 Name
Emergency Contact 2 Phone Number
Does your child have any food restrictions, allergies, disabilities or medical conditions we should be aware of? *
If yes, please explain
Child lives with *
Current single parent household?
Clear selection
What is the primary language spoken at home? *
Please check each box below indicating that you have read the following expectations *
Required
A copy of your responses will be emailed to the address you provided.
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