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BEFORE & AFTER SCHOOL REGISTRATION
BEFORE & AFTER SCHOOL SY2022-2023
Please Select one:
*
Before School
After School
Both
STUDENT'S NAME #1
*
First Name
Last Name
GRADE
*
STUDENT'S NAME #2
First Name
Last Name
GRADE
STUDENT'S NAME #3
First Name
Last Name
GRADE
STUDENT'S NAME #4
First Name
Last Name
GRADE
PARENT INFORMATION
Please complete all required fields
PARENT/GUARDIAN (Primary):
*
First Name
Last Name
Email
*
example@example.com
CELL PHONE:
*
-
Area Code
Phone Number
WORK PHONE:
*
-
Area Code
Phone Number
PARENT/GUARDIAN (Secondary):
First Name
Last Name
Email
example@example.com
CELL PHONE:
-
Area Code
Phone Number
WORK PHONE:
-
Area Code
Phone Number
THE FOLLOWING ADULTS ARE AUTHORIZED TO PICK UP MY CHILD FROM After SCHOOL:
PARENT/GUARDIAN (1):
*
First Name
Last Name
CELL PHONE #:
*
-
Area Code
Phone Number
WORK PHONE#:
*
-
Area Code
Phone Number
PARENT/GUARDIAN (2):
First Name
Last Name
CELL PHONE#:
-
Area Code
Phone Number
WORK PHONE#:
-
Area Code
Phone Number
PERSON(S) OTHER THAN PARENT/GUARDIAN AUTHORIZED TO PICK UP MY CHILD:
NAME OF PERSON #1
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
RELATIONSHIP:
GRANDPARENT
FAMILY FRIEND
DAYCARE PROVIDER
RELATIVE-OTHER
NAME OF PERSON #2 (OPT)
First Name
Last Name
Phone Number
-
Area Code
Phone Number
RELATIONSHIP:
GRANDPARENT
FAMILY FRIEND
DAYCARE PROVIDER
RELATIVE-OTHER
NAME OF PERSON #3 (OPT)
First Name
Last Name
Phone Number
-
Area Code
Phone Number
RELATIONSHIP:
GRANDPARENT
FAMILY FRIEND
DAYCARE PROVIDER
RELATIVE-OTHER
Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: