After School Program Enrollment Form

WhyWisdomWorks After School Program Registration

2025
We are excited to announce the opening of registration for the upcoming Why Wisdom Works Afterschool Program launching Monday, September 8, 2025!

At Why Wisdom Works, we empower young people (ages 5–18) to discover and develop their strengths through hands-on learning, mentorship, and values-driven experiences. Our program is where wisdom meets action, building tomorrow’s confident, creative leaders. Rooted in our core values of Growth, Impact, Creativity, Integrity, and Mentorship, we are committed to guiding every child toward meaningful personal and academic development.

We utilize your child’s insurance coverage to help cover the cost of participation. If insurance is not applicable or preferred, we also accept private pay. Families interested in private pay must contact us directly at (937) 937-238-1049 or registration@whywisdomworksllc.com for more information.

Please complete and submit one form per student being enrolled in the After School Program.
Parent's Name*

First NameLast Name
Parent's Phone Number*

Area CodePhone Number
Parent's Email*
Student's Name*

First NameLast Name
Student's Date of Birth*

MonthDate/Year of Birth
Grade in fall (2025)*

KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12
Do Student have a Medicaid Card?*

YESNO
Indicate the day(s) that you anticipate utilizing the After School Program:*

MondayTuesdayWednesdayThursdayFridayAll
Please indicate your child's default dismissal plan:
My child will remain in the After School Program until being picked up on:

MondayTuesdayWednesdayThursdayFriday
Please specify each person, including the name of parents, who has permission to pick up your child from the After School Program.
Authorized Person 1:

First NameLast Name
Phone Number 1:

Area CodePhone Number
Authorized Person 2:

First NameLast Name
Phone Number 2:

Area CodePhone Number
Authorized Person 3:

First NameLast Name
Phone Number 3:

Area CodePhone Number
Statement of Fees (Medicaid)

We utilize your child’s insurance coverage to help cover the cost of participation. If insurance is not applicable or preferred, we also accept private pay. Families interested in private pay must contact us directly at (937) 937-238-1049 or registration@whywisdomworksllc.com for more information.
Open Enrollment & Waitlist Policy
- To participate in the program, the parent/guardian will be required to complete the onboarding packet sent to them via email/text. If you don’t see it in your inbox, please be sure to check your spam or junk folder.
- Our team is available to walk you through the onboarding process and answer any questions you may have. If your child has participated in our program, they may not need to resubmit onboarding documents. You will be notified by email if any additional documentation is required.
- The After School Program ends promptly at 6:30 p.m. After 6:30 p.m., you may be charged a fee for each 10 minute interval.
- If a student’s use of the program exceeds the number of days of his/her contract, the hourly rate will apply for the additional hours.
- We offer open enrollment, but please note we have a limited number of spots available. If the program reaches capacity, your child will be placed on a waitlist and you’ll be notified when a space becomes available.
  
  We are honored to serve your family and look forward to the growth, creativity, and confidence your child will develop during their time with us this school year.
  
  To get started, please complete the registration form today. A separate registration form and onboarding documents are required for each child you wish to enroll.
I have read and understand the Statement of Fees and Statement of Policy contained here.*

Agree
Should be Empty:

WhyWisdomWorks After School Program Registration

Statement of Fees (Medicaid)

Open Enrollment & Waitlist Policy