October After School Online Registration
Event Timing: October 9th- October 31st
This online form is to allow me to know who will be attending this month on which days. The information will be deleted on the second to last week of each month and you may register for the next month. I  want all families to sign up in advance each month here. I understand that emergencies happen and students may need to stay on short notice. If this is the case please contact me using one of the following methods. Contact Lynette Gillis SCOPES Director at (828)782-1106 or scopes@icimagine.org.  This form does not replace the paper form to register students. If you have not filled one out for me this year you will need to do so. I need those forms for the more important information that is on them.

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Student Last Name *
Student First Name *
Student Grade *
Parent Name *
Parent Phone Number *
Parent Email *
What days will your child be attending? Please specify days your child will attend if not on a regular basis. e.g. 10/9 ,10/18 , Tuesday, Thursday only etc.? *
Dietary restrictions *
I understand that payment is due before the first time my child stays or upon pickup that day unless arrangements have been made between myself and the Director along with paper registration form if I have not already turned one in. *
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