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Registration Form
21st Century Community Learning Center - Cahokia Unit School District #187
Welcome to the 21st CCLC After School Program! The Program meets Monday through Thursday.
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Today's Date
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First Name
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Your answer
Last Name
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Your answer
Grade Level for 2020-2021 School Year
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Choose
Kindergarten
1
2
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5
6
7
8
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10
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12
School Attending in Fall 2020
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Choose
E. Morris
Maplewood
Lalumier
Huffman
Penniman
Estelle Sauget School of Choice
Oliver Parks Sixth Grade Center
7th Grade Academy
8th Grade Academy
Cahokia High School
Out of District
Gender
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Female
Male
Student Date of Birth
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DD
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YYYY
Home Address
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Your answer
Apt. #
Your answer
City
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Your answer
State
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Your answer
Zip
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Your answer
Parent/Guardian Name:
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Your answer
Home Number:
Your answer
Work Number:
Your answer
Cell Number:
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Your answer
Parent's Email Address
Your answer
Does your child have any siblings within the district participating in the program? If so, please list the name of the student(s) and the location of the school?
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Your answer
Does your child receive special education services?
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Choose
Yes
No
Does your child have allergies?
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Yes
No
We are working to potentially revise how our 21st Century program is structured. If we are able to provide components of the program twice a month on Saturdays, would your child be able to participate?
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Yes
No
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