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After School Registration
2021 Spring Semester (March 1 - May 27th)
Kindergarten - 5th Grade
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Child's Full Name
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Nick Name
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Date of Birth
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MM
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DD
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YYYY
Age & Grade
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Current School Attending
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Sex
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Female
Male
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Other:
Street Address, City, State and Zip
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Mailing Address (If Different)
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Father/Primary Guardian
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Occupation
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Email Address
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Home Phone
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Cell Phone
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Mother/Guardian 2
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Occupation
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Email Address
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Home Phone
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Cell Phone
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Does your child have any special needs?
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Please list any Chronic medical Conditions & current medications they are taking
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Please list Allergies (including Food)
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Please list other children in the family (name and age)
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Days you would like your child to attend After School Programs (2:30-4:00pm)
Monday - After School in the Garden
Tuesday - "Drums Alive" and Drumming- Creative movement and music
Wednesday - Friendsday; Games, Crafts, & Fun
Thursday - Non-contact Sports and Physical activities
If space becomes limited, which day is your preferred day?
Monday - After School in the Garden (K-5th grade)
Tuesday - "Drums Alive" and Drumming- Creative movement and music
Wednesday - Friendsday; Games, Crafts, & Fun
Thursday - Non-contact Sports and Physical activities
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By clicking the box below I authorize all the above information is correct to the best of my knowledge and I understand that All application list items and parent notes are understood.
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