Aftercare Application Form

Aftercare Application Form

Apply for aftercare services by providing your child's details, school information, and parent/guardian contact information.
Child Information

Please provide the details of the child to be enrolled.
Child's Full Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2
CityRegionPostal / Zip Code
Grade
Name of Current School
Does the child have allergies?
Describe the allergies
Parent/Guardian Contact Information

Please provide the primary contact information for the parent or guardian.
Parent/Guardian Full Name

First NameLast Name
ID number
Relationship to Child
Primary Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityRegionPostal / Zip Code
Parent/Guardian Full Name 2

First NameLast Name
ID number
Relationship to Child
Primary Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact Information

Provide a secondary contact in case of emergency.
Emergency Contact Name

First NameLast Name
ID number
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Persons for Pickup

List any additional persons authorized to collect your child from aftercare.
List names ,ID and contact numbers of authorized persons for pickup
Should be Empty: