After- School Program Application/ Emergency Contact
Please fill out the information below if you are interested in your child attending After School program. 
- Once the application is complete please submit
- You are able to submit other camp payment through this QR code.
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Date *
MM
/
DD
/
YYYY
Child's name *
Parents name *
Email address
I am the Childs *
Call me at these numbers *
Alternative contact *
Childs Doctors information (please list name, phone number, medications, allergies, life threatening) *
Additional comments
By signing this form, I authorize the caregivers to call 911 on behalf of my child in case of emergency! *
I give the staff at U Matter 2 After-School Program for individuals with disabilities permission to transport my child from school to community outings and to the parents home. 
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