2020-21 Youth Program/After School Interest Form
Parents/Caregivers: West Side Community Services operates a drop-in youth program for kids age 6-19 at our community center on Vermont Street. Please complete this form with your needs this upcoming school year. We will contact you with more information. If you have any questions please call us at 884-6616 and ask for Margaret or Kate.
Do you plan on sending your child to afterschool/youth program at WSCS this school year?
Yes, but only on days the bus can drop them off.
No, I am not comfortable sending my child to afterschool right now
No, I do not have transportation to pick them up.
If you answered NO, would you be interested in any of the following services?
Virtual social-emotional programming
"Grab and Go" meals
If you answered YES or MAYBE, please enter the names of your child(ren) here
Parent/Caregiver Phone Number
Parent/Caregiver E-mail Address
If you need care for your child, what days will you need help?
If you need care for your child, what time of day will you need help?
9:00 am - 12:00 pm
12:00 - 5:00 pm
5:00 - 8:00 pm
All Day 9:00 am - 5:00 pm
Depends on the day of the week
If we offered a half-day preschool program (ages 3-5) would you be interested in registering a child?
Yes but only if it is full-day
Will your child need any of the following?
Technical assistance/help with virtual schooling
Quiet space to do school work
Extra help with reading, ELA and/or math
If we offered virtual tutoring for your child, would you be interested?
Please add any questions, comments or additional needs in the box below.
Never submit passwords through Google Forms.
This form was created inside of West Side Community Services.