Elementary Registration 2026-2027

Please Read Carefully:

Our afterschool program takes place at Cheryl's Lodge from 2:45-3:45pm on Mondays through Thursdays. This program is open to students who attend Orenda, Tesago, Arongen, Karigon, Shatekon, and Skano ONLY. A bus will bring your child to Cheryl's Lodge after school. Parents are responsible for making arrangements to pick their child up after program ends.

Our before school program takes place at Okte Elementary from 8:15-9am on Tuesdays and Thursdays. This program is for Okte students ONLY. Parents are responsible for making arrangements to bring their child to school by 8:15am. We will dismiss the students to their classrooms at 9am.

Unfortunately, we are not able to offer programming at Chango at this time.

I would like to enroll my child into the following program:

Child's Full Name:

First NameLast Name

Child's Date of Birth:

Child's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What school does your child attend?

What grade is your child entering in Fall 2026?

What is the name of your child's teacher?

Does your child have an IEP? If so, what services do they receive?

Does your child have any behavioral needs we should be aware of? If so, please explain.

Are there any specific areas (academic or social) that you would like your child to focus on?

Does your child have any allergies, medical conditions, or dietary restrictions we should be aware of?

We are working to bring in outside community programs to talk to our students about such topics as bullying, positive decision making, internet safety, etc. Are you comfortable with your child attending these programs, and are there any other topics would you like to see covered?

Parent/Guardian 1 Name:

First NameLast Name

Parent/Guardian 1 Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian 1 Email Address:

example@example.com

Parent/Guardian 2 Name:

First NameLast Name

Parent/Guardian 2 Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian 2 Email Address:

example@example.com

Emergency Contact Name (MUST be someone other than parent/guardians listed above):

First NameLast Name

Emergency Contact Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Cheryl's Lodge staff uses the Remind app to communicate with families and notify them of upcoming events, etc. If you would like to be added to the Cheryl's Lodge Remind Classroom, please list the phone number you would like us to use for the app.

Are there any barriers to your child being able to attend program consistently? (ie. sports, family trips, lack of transportation, etc)

Please note: We do have a van that can transport students home after the program, however space is very limited and we may not be able to accommodate everyone. A separate sign up will be sent out for that.

Cheryl's Lodge often uses pictures and videos for promotional materials and websites for CAPTAIN Community Human Services and our partner organizations. Do you give permission for your child's photo and video to be used for these purposes?

Does your child have permission to walk home after programs are finished? (if applicable)

Other

I agree and understand that in order to help students in their academic work, Cheryl's Lodge staff may be in contact with my child's teachers and school professionals. I give permission for Cheryl’s Lodge staff and volunteers to access and share information with the school district.

I agree and understand that in order to help my child with their academics, Cheryl's Lodge staff will need access to their Shen portal, Google classroom, and other virtual systems being used at the school. I give permission for Cheryl’s Lodge staff and volunteers to access these systems at their discretion to assist my child with their academic and educational needs.

I understand that I can contact the Cheryl's Lodge Program Manager for support if my family has any areas of need. As a family enrolled at Cheryl's Lodge, we have access to all Cheryl's Lodge/CAPTAIN resources

Parent/Guardian Signature:

Date Signed:

Thank you for registering for the 2026 - 2027 school year. You will be contacted by Cheryl's Lodge Staff to let you know if your child is accepted into the after school program or is being added to the waitlist. If your child is accepted you will receive more information as the schools continue to make definitive determinations regarding their schedule, process, and procedures. If you have any questions please feel free to call Rachel McCann at 518-373-8873 or email at Rachel@captaincares.org

Cheryl’s Lodge Elementary School Afterschool Program 2026-2027

Child Info:

Parent/Guardian Info: