After-School Form

Please complete the form below. Required fields marked with an asterisk *

Child's Name*

Answer required for "Child's Name"

Grade Level*

Answer required for "Grade Level"

Child's Sex*

Answer required for "Child's Sex"

Male

Female

Child's Birthdate*

Answer required for "Child's Birthdate"

Contact Information

Father's First Name*

Answer required for "Father's First Name"

Last Name

Answer required for "Last Name"

Email 1

Answer required for "Email 1"

Mobile Phone

Number Required

Home Phone

Number Required

Work Phone

Number Required

Contact Information

Mother's First Name*

Answer required for "Mother's First Name"

Last Name

Answer required for "Last Name"

Email 1

Answer required for "Email 1"

Mobile Phone

Number Required

Home Phone

Number Required

Work Phone

Number Required

Child's Living Arrangements*

Answer required for "Child's Living Arrangements"

Both Parents

Mother

Father

Other

Child's Legal Guardian (s)*

Answer required for "Child's Legal Guardian (s)"

Both Parents

Mother

Father

Other

The child may be released to the person (s) signing this agreement and the following: *

Answer required for "The child may be released to the person (s) signing this agreement and the following: "

Name and Contact phone number for person to contact for emergency when the parents cannot be reached.*

Answer required for "Name and Contact phone number for person to contact for emergency when the parents cannot be reached."

Please fix the highlighted areas below before submitting.

After-School Form