Afterschool Care Registration

Thank you for your interest in our Introductory Tuesday After School Care Program. The program has been designed to assist families with after school child care, student homework assistance and a child friendly family meal. Our hope is to make your Tuesday more tranquil as you unwind with other parents and volunteers while enjoying a good meal without the preparation or clean up.

To assist us with planning we ask that you commit to the full 8 week program. If you need to miss a session please notify us as early as possible either by email at Helpinghands@firstchurchprinceton.org or by text to our Helping Hands Cell Phone (508) 210-6915.

We are committed to keeping you and your children safe and healthy. We will be requiring masks for all persons and volunteers in the program. Social Distancing will be observed during snack and meal time when masks are removed. Cleaning and sanitizing protocols will also be followed.

A suggested weekly donation of $20 per family of four will be used to cover meal costs. If this is a financial burden please contact the Program Director.

This is an introductory or "pilot" program. We plan to evaluate the program after 6 weeks to get participant suggestions and determine what changes need to be made.

If you have further questions please email: Helpinghands@firstchurchprinceton.org or call/text (508) 210-6915

We look forward to seeing you on September 7. If you would like to visit the program location for a child orientation let us know.

Rachel Kopec, Program Director

All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

First Name*

Last Name*

FemaleMale

Birth Date*

MonthDayYear

School Attending

Grade Attending*

YesNoOther

If yes please list, including any food or drug allergies.

Does your child have any medical conditions?*

Does your child require any medication during their time at the program? If yes, please list these medications.

YesNoOther

First Name

Last Name

FemaleMale

Birth Date

MonthDayYear

School Attending

Grade Attending

YesNoOther

If yes please list, including any food or drug allergies.

Does your child have any medical conditions?

Does your child require any medication during their time at the program? If yes, please list these medications.

YesNoOther

First Name

Last Name

FemaleMale

Birth Date

MonthDayYear

School Attending

Grade Attending

YesNo

If yes please list, including any food or drug allergies.

Does your child have any medical conditions?

Does your child require any medication during their time at the program? If yes, please list these medications.

Home Phone*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Doctors Name*

First NameLast Name

Doctors Phone Number*

Area CodePhone Number

Dentist's Name*

First NameLast Name

Dentist's Phone Number*

Area CodePhone Number

Full Name*

First NameLast Name

Home*

Area CodePhone Number

Cell*

Area CodePhone Number

Work

Area CodePhone Number

E-mail*

YesNo

If your address is different than the childs please fill out the info below. Otherwise move onto the next section.

Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Full Name

First NameLast Name

Home

Area CodePhone Number

Cell

Area CodePhone Number

Work

Area CodePhone Number

E-mail

YesNo

If your address is different than the childs please fill out the info below. Otherwise move onto the next section.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please list the people authorized to pick up your child/children.*

Does your child have any siblings who will not be attending the program?*

If yes, what is their age(s)?

Does your family have any dietary restrictions or preferences? Please describe:

Full Name*

First NameLast Name

Relationship to child*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home*

Area CodePhone Number

Cell*

Area CodePhone Number

Work

Area CodePhone Number

All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

I ceritfy that I am the parent or guardian of the above named child/children. I agree to hold harmless and release from liability the Helping Hands Program of the First Congregational Church of Princeton, UCC or any employee, representative or volunteer thereof for any action, claim, or damage that may arise as a result of my child's/children's participation.

In the event that my child/children need emergency or medical treatment, every attempt will be made to contact us, the parent/guardian. In the event that I/we cannot be contacted, my electronic signature below gives my/our permission to the Helping Hands staff to secure prompt treatment.

Signature*

Helping Hands Registration Form

After School Care Registration

Student Information 1

Student Information 2

Student Information 3

Family Residence Information

Child/Children's Health Care Provider

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Infomation

Emergency Contact - Other than Parent/Guardian

Health & Safety Waiver