Phoenix After School Registration 2026-2027

The Salvation Army Phoenix After School Program Registration

School year 2026-2027 (Note Student Must Have Completed Kindergarten to be Enrolled.)
Welocme to the 26/27 Schoo year! The Phoenix After School Program operates Monday- Friday, 2:30PM- 5:30PM Starting Monday, September 14th 2026 following the Canandaigua City School district calendar. We accommodate first grade through six grade students. The weekly cost is $40.00 for first student and $25.00 for each additional sibling. We provide a healthy light snack, homework help, along with a rotating schedule of engaging activities for the students to enjoy.
Student Info
Students Name

First NameLast Name
Gender
Students Current Age
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade Attending for the 26-27 School Year
Guardian Info
1st Parent/Guardian Name

First NameLast Name
1st Parent/Guardian Main Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
1st Parent/Guardian Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
1st Parent/Guardian Email
example@example.com
Students Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2nd Parent/Guardian Name

First NameLast Name
2nd Parent/Guardian Main Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
2nd Parent/Guardian Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
2nd Parent/Guardian Email
example@example.com
2nd Parent/Guardian Address if different from Students Main Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list Emergency Contact OTHER THEN YOURSELF

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What is the Relationship of the Emergency Contact to the Student
Additional Emergency Contact

First NameLast Name
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What is the Relationship of the Emergency Contact to the Student
Please List All People Authorized to Pick Up Your Student Including Yourself.
ID Require for All Authorized Pick Persons

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ID Require for All Authorized Pick Persons

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ID Require for All Authorized Pick Persons

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ID Require for All Authorized Pick Persons

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ID Require for All Authorized Pick Persons

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Student Release Forms
From time to time we will be going to the gym in the main Salvation Army Building 110 Saltonstall St. By initialing below you give your child persmission to participate in this activities.
Initials
Print out form, fill out, scann, email to elizabeth.malanga@use.salvationArmy.org
There is a strict pick up time of No Later then 5:30PM. Please give a courtesy call if you expect to be late picking up your child. The first time of late pick will be a warning only. Any late pick up going forword for the rest of the school year, we will give a 5 minute grace period till 5:35PM. After that, starting at 5:36 you will be charged an automatic $5.00 late pick up fee with $1.00 per each additional minute there after till time of arrival. This will be inforced.
Initials
Please note that in orer for your child to be fully enrolled and start on the first day of After School program on Sept. 14th, we need a compleated registraion form which also includes up to date immunizatioin records and first weeks payment. The dead line to receive these item will be Thursay morning of Sept. 10th. Space is limited to 20 students only and we do have a waiting list which we will have to move onto the next person if all requested items are not received in a timely manner. Thank you for your understanding by initialing below.
Initials
Medical
Immunization Records are Required to Participate in the After School Program

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Please list ANY allergies your student has
Please list ANY Food intolerance your student may have. i.e. Dairy, fructose
Tell us about your child. Do they have any special needs/ medical conditions/ etc.
Does your child require any medication to be administered by us during after school hours? (2:30-5:30) If so, please list name of medication, dosage, & how often. (*If your child requires medication we will have additional forms that we will need you to complete.)
Do you authorize us to administer the medication listed above?
Primary Care Doctor

First NameLast Name
Doctor Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Insurance Carrier
Policy number
I do hereby give permission to obtain medical treatment and procedures for my child as may be appropriate in emergency circumstances, including treatment by physicians, hospital and clinic personnel. and other appropriate health care providers.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

The Salvation Army Phoenix After School Program Registration

Student Info

Guardian Info

Student Release Forms

Medical

I do hereby give permission to obtain medical treatment and procedures for my child as may be appropriate in emergency circumstances, including treatment by physicians, hospital and clinic personnel. and other appropriate health care providers.