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.
Today's Date *
MM
/
DD
/
YYYY
Do you plan on sending your child to afterschool/youth program at WSCS this school year? *
If you answered NO, would you be interested in any of the following services?
If you answered YES or MAYBE, please enter the names of your child(ren) here
Parent/Caregiver Name *
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?
If we offered a half-day preschool program (ages 3-5) would you be interested in registering a child?
Clear selection
Will your child need any of the following?
If we offered virtual tutoring for your child, would you be interested?
Clear selection
Please add any questions, comments or additional needs in the box below.
Submit
Never submit passwords through Google Forms.
This form was created inside of West Side Community Services. Report Abuse