Lexington Public Schools Afterschool Programs Application 2024-2025

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Registration will be open from July 29-August 4.

First and Last Name (Parent/Guardian) *

Phone Number *

Address *

Email Address *

(Child #1) Student First & Last Name *

School/Grade Level *

Middle School Sixth Grade

Middle School Seventh Grade

Middle School Eighth Grade

(Child #2) Student First & Last Name

School/Grade Level

Middle School Sixth Grade

Middle School Seventh Grade

Middle School Eighth Grade

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I give permission to LPS Afterschool Programs staff to photograph my child(ren) for use on the school website or in promotional material for the state program.

Yes

I give permission to LPS Afterschool Programs staff to take my child off school premises for field trips and other program events.

Yes

I grant permission for my child(ren) to participate in the Afterschool programs. I hereby release Lexington Public Schools, its employees, and volunteers from any financial responsibility or claims for the sickness and/or accident to my child(ren) during the Afterschool programs. I understand that these programs are sponsored by Lexington Public Schools and that my child(ren) must follow all school rules set forth by Lexington Public Schools. I understand that violations of school rules may result in suspension or removal from the program.

By typing your name you are electronically submitting your signature.

If any questions, please contact Amber Nichols, Extended Learning Coordinator, at the Lexington Central Office or at (308).324.1228

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