After-School Program Enrollment
Enrollment form for an after-school program: days needed, pickup plan, and emergency contact.
After-School Program Enrollment
JaxForm
After-School Program Enrollment
Please complete this form to enroll your child in our after-school program. This information helps us ensure their safety and provide the best care during program hours.
Student Information
Student’s Full Name*
First
Last
Student’s Grade Level*
Program Enrollment Details
Which days will your child attend?*
Authorized Pickup Person(s)*
Please list all individuals authorized to pick up your child.
Typical Pickup Time*
Emergency Contact Information
Emergency Contact Full Name*
First
Last
Someone we can reach if you are unavailable.
Emergency Contact Phone Number*
Medical Notes & Allergies
Allergies or Important Medical Notes
Please describe any allergies, medications, or medical conditions we should be aware of.
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