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Weestar CIASP
Weestar corporation is a non-profit company that has been operating after school programs in Clarksburg for over 6 years. We have programs in Wilson Wims and Cedar Grove Elementary School. Little Bennett students also ride on school bus to join our programs.
This year, we will continue to operate in these schools and offer you a very competitive price. Please join us by filling this form.
Student's Name *
Your answer
Gender *
Your answer
Date of Birth *
Your answer
Student's Grade *
Your answer
Parent/Guardian Name
Your answer
Class
Schools
Phone Number
Your answer
Parent/Guardian Email
Your answer
Home Address
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone# *
Your answer
Date of Child's Last Tetanus( or DTP) Shot *
Your answer
Child's Physician's Name *
Your answer
Child's Physician's Address *
Your answer
Child's Physician's Phone# *
Your answer
Health Insurance Company *
Your answer
Insurance Policy# *
Your answer
Others *
Your answer
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