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Alley Registration
The Alley is an after school program for students in 5th grade through 8th grade. The Alley building is owned by the Lamoni SAFE Coalition and ran by AmeriCorps Youth Launch members. If you have any questions please contact Shirley Kessel at: 641-414-8093 or Adriene Kelley at: 641-414-5471 with any questions. Thanks!
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Parent or guardian phone number *
Child's Name *
What days will your child attend? *
Required
Parent/Guardian Phone Number: *
Parent/Guardian email: *
Parent/Guardian place of work: *
Other emergency contacts: *
Allergies/dietary restrictions? *
Should a medical professional need to be contacted, please indicate preference. (Include number) *
As parent/guardian I give my consent to have my child receive first aid by facility staff, and if necessary, be transported to recieve emergency care. I understand that I will be responsible for any charges not covered by insurance (if any). I also give my permission for the alternate emergency contact to act on my behalf, until I am available.  *
Photo/press release: throughout the program there will be opportunities for your child to be photographed. Some of these photos may appear on various organizational social media accounts, newspapers, etc. Please indicate if your child can be photographed.  *
How is your child most likely to be picked up from the Alley?
If they walk/bike can they leave prior to 5:00?
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Does your child have permission to sign out/leave when they would like? (Leave early, go to sports, go to businesses in town?)
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