WIMA & WIHI After School Care Registration Form

WIMA & WIHI Before & After School Care

Registration Form
We understand that drop off and pick for your student may be challenging to schedule. We will be offering before school care starting at 8:00am and after school care until 5:00 pm. Student will be socially distanced and supervised in the area outside the cafeteria when weather permitting or inside the cafeteria. Students will use this time to work on school work. If you are interest either before school, after school or both please complete the form blow.

As a reminder- There is no after care available on Half Days.
I am interested in: Please check all that apply *

Before School Care After School Care
Student Information:
Please list all students participating in the Before and/or After Care Program: *
Student(s) Home Address: *

Street Address

Apt. # Or Lot #

City State / Province

Postal / Zip Code
Parent/Guardian Information:
Parent/Guardian Email #1: *
example@example.com
Parent/Guardian Name #1: *

First Name Last Name
Parent/Guardian Phone Number #1: *
Please enter a valid phone number.
Optional - Parent/Guardian Name #2:

First Name Last Name
Optional - Parent/Guardian Email #2:
example@example.com
Optional - Parent/Guardian Phone Number #2:
Please enter a valid phone number.
Please list any additional names who have permission to sign your student out of our aftercare program: *Please note-for the safety of our students and staff we may ask for ID upon pickup:
Please mark each day that you are registering for: *
Is your child in good health? *

Yes No
Does your child have any activity restrictions due to health issues? *
If no, please put N/A
Is your child current with his/her immunizations? *

Yes No
Is your child's immunization record or appropriate waiver on file with the school? *

Yes No
Policies and Procedures:
By registering your child(ren), you agree to follow the policies and procedures as outlined in the registration form, including the following:

Pick-up after 5:00 p.m. regularly may result in your student(s) being excluded from the program.

After Care is not offered on half days

All students must sign in and parents/guardians must sign them out for after care only.

Information on your child's emergency contact list must be kept current. All changes must be made in writing. Students must abide by the WIMA's & WIHI's Code of Conduct at all times.

If a student does not abide by school and district policies, the student will lose the ability to attend after school program.
By signing this - the Parent/Guardian agrees to adhere to all the policies and procedures of the Before & After Care Program. *

Clear
Should be Empty:

WIMA & WIHI Before & After School Care

Student Information:

Parent/Guardian Information:

Policies and Procedures: