Elevate Edwards Spring 2027 Enrollment

Elevate Edwards Spring 2027 Enrollment

Complete this form to request a spot for the free after-school program at Edwards Elementary (grades K–5).
Student Information
Student First Name
Student Last Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade in Spring 2027
Current School
Which school?
Home Language

Other
Parent / Guardian Information
Parent / Guardian Full Name

First NameLast Name
Relationship to Student
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Preferred Language for Communication
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency and Pickup
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pickup People
Health and Safety
Does the student have any allergies?
Please describe the allergies and any relevant details
Medical conditions or medications staff should know about
Consents, Media Release, and Signature
Acknowledgement(s)
Photo / Media Release
Parent / Guardian Signature Name

First NameMiddle NameLast Name
Parent / Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Consent Statement
Acknowledgement Summary
Should be Empty: