Learner Support Time Sign-Up

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Please complete this form for each child you would like to participate. If you have more than one child participating, please compete a separate form for each child.

Learner Support Time will begin on Monday October 2nd, 2023

If you have any questions, please contact Nicole Brubaker at 717-664-1807 or at brubakern@manheimcentral.org.

First Name of Learner *

Last Name of Learner *

Grade Level *

Parent/Guardian Name (first and last) *

Phone Number *

Email Address *

Please select the option that applies for your child: *

My child is in either 5th or 6th grade and will attend each Monday and Wednesday.

My child is in either 7th or 8th grade and will attend each Tuesday and Thursday.

I understand that I will need to pick my child up at 3:55 PM at the front of the building. *

Yes

Required

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