Rogers After-School Program Sign Up
Full Name
*
First Name
Middle Name
Last Name
Grade Level
*
Please Select
5th
6th
7th
8th
9th
10th
11th
12th
for Incoming A.Y. '12-'13
Email
Phone Number
Parent's Email
example@example.com
High School
*
Please Select
Maple Grove Middle School
Maple Grove High School
Prairie View Middle School
Saint Michael-Albertville High School
Rogers Middle School
Rogers High School
Saint Michael-Albertville Middle School East
Saint Michael-Albertville Middle School West
Trilogy STEM Academy
Other
Emergency Contact
*
First Name
Last Name
Relationship
*
ex. Father, Mother, etc.
Phone Number Of Person To Contact In Case Of Emergency
*
Please enter a valid phone number.
Please verify that you are human
*
*Please be advised that you will need to present your student ID upon checkin
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