Agriscience Afterschool Program Registration Form
Fill out the form carefully for registration. Call 231-796-5805 for assistance.
Student Name
First Name
Middle Name
Last Name
Student Phone
Please enter a valid phone number.
Student E-mail
example@example.com
Current Grade of Student
Please Select
Grade 7
Grade 8
Grade 9
Grade 10
School District of Student
Please Select
Big Rapids
Chippewa Hills
Crossroads
Evart
Morley Stanwood
Reed City
Tri County
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 1
First Name
Last Name
Parent/Guardian 1 Phone
Please enter a valid phone number.
Parent/Guardian 2
First Name
Last Name
Parent/Guardian 2 Phone
Please enter a valid phone number.
Submit
Should be Empty: