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Cougar Club After School Registration 2019/20
YC School District - Yamhill Carlton Together Cares - Cougar Club
Student Information
Child's Name (First, Last) *
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Birthdate *
MM
/
DD
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YYYY
Current Grade (Fall 2019) *
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School Attending (Fall 2019) *
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Teacher (Fall 2019)
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Mailing Address *
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City, State, Zip Code *
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Email Address *
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Home Phone *
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Attendance
Please check all the days that your child will most likely attend. *
Required
Please note any additional details regarding your child's attendance.
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Health Information
Cougar Club Staff do not have access to school records. Please tell us about any allergies, medications, or health concerns your child has that you would like our staff to be aware of. *
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I agree to the following statements
Behavior Expectations *
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Financial Responsibility *
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Photographs, Videos, Recordings *
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Medical/Liability *
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