G Road x Emerson (2026-2027)

G Road Afterschool at Emerson Elementary (2026-2027 School Year)

Register now for G Road Afterschool at Emerson! Please note that registration is only open to students enrolled at Emerson Elementary for the 2026-2027 school year.
The Emerson School/G Road extended learning programs are funded in part by a Nita M. Lowey 21st Century Community Learning Centers (21st CCLC) Title IV-B program federal grant from the U.S. Department of Education and administered by the Arizona Department of Education.
Student Name

First NameLast Name
Student Date of Birth

MonthDayYear
Date
I confirm that student(s) are enrolled at Emerson Elementary for the 2026-2027 school year.
Student Grade (2026-2027 School Year)
Does your student have any allergies or medical conditions?
If yes, please list all allergies or medical conditions and provide any necessary instructions.
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name (other than parent/guardian)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you grant permission to G Road to use photographs and/or video of your student(s) in publications, news releases, online, and in other communications related to the mission of the organization?
Does your student have an IEP or 504 plan?
If yes, do you consent to us reviewing this with school staff so we can provide proper supports?
List all adults approved to pick up the student (full names).
Transportation:
T-shirt size

Other
Is there anything else that would be helpful to know about your child?
Should be Empty:

G Road Afterschool at Emerson Elementary (2026-2027 School Year)