Free After-School Program Admission Form

After-School Program Admission Form
Please complete this form to enroll your child in our after-school program and provide them with engaging, educational activities.
Student Information
Name
Date of Birth
Grade Level
School Name
Parent/Guardian Information
Name
Relationship to Student
Phone number
Address
Program Details
Select the activities/programs you are enrolling in:
Homework Assistance
Arts & Crafts
Sports & Recreation
STEM Activities
Music & Drama
Preferred Start Date
Does your child have any allergies or medical conditions we should be aware of?
If yes, please specify:
Emergency Contact
Name
Relationship
Phone number
Institution Representative | |
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