GWS ASEP Application 2019
Please complete this application for the GWS After School Enrichment Program. You may submit your payment through UniPay using the link below, or your child may bring in cash or a check for $60.00. Please make checks payable to Town of Marshfield (memo: GWS ASEP).

UniPay: Please go to www.mpsd.org and choose the “parents and students” tab, then choose “UniPay Online Payments”. Choose "enrichment" from the toolbar on the left, click "after school enrichment program," and complete the payment information. If you are paying for more than one child, put the total for all children into the "pay amount" box and include all of the first names in the "first name" box.

Contact Ms. Lusardi at clusardi@mpsd.org with any questions. Thank you!

Marshfield Public School District is an Equal Opportunity/Affirmative Action employer. Marshfield Public School District does not discriminate on the basis of race, color, religion, national origin, gender, gender identity, sex, sexual orientation, disability, homelessness, or age in programs, activities, or employment.

Email address *
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Grade *
Student's Homeroom Teacher *
Student Allergies/Restrictions (write "none" if your child has no allergies or restrictions) *
Your answer
First Choice Class *
Second Choice Class *
Third Choice Class *
EMERGENCY CONTACT 1: name, relationship, phone number (please separate information with commas) *
Your answer
EMERGENCY CONTACT 2: name, relationship, phone number (please separate information with commas) *
Your answer
DISMISSAL - Please notify the director, preferably in writing, if there is a change to your selection below. *
CAR LINE PICK UP AUTHORIZATION 1 – Please write the NAME, RELATIONSHIP, and PHONE NUMBER of person 1 (other than parent/guardian) who is authorized to pick up your child from the program. Please separate information with commas. Students will not be allowed to leave without authorization from parent/guardian. Write "none" if applicable. *
Your answer
CAR LINE PICK UP AUTHORIZATION 2 – Please write the NAME, RELATIONSHIP, and PHONE NUMBER of person 2 (other than parent/guardian) who is authorized to pick up your child from the program. Please separate information with commas. Students will not be allowed to leave without authorization from parent/guardian. Write "none" if applicable. *
Your answer
EMERGENCY MEDICAL PERMISSION – I authorize medical treatment to be given to my child if needed. I understand that in an emergency, whenever possible, an attempt will be made to contact a parent/guardian prior to the use of this permission. *
PHOTO CONSENT – I authorize the program to use and reproduce photographs taken of my child and to circulate these photographs for advertising or publicity purposes including online publicity (GWS twitter). *
PARENT/GUARDIAN ELECTRONIC SIGNATURE – by typing my name below, I give my child permission to participate in the GWS After School Enrichment Program. *
Your answer
PARENT/GUARDIAN CONTACT INFORMATION: name, home phone number, work/cell phone number (please separate information with commas) *
Your answer
A copy of your responses will be emailed to the address you provided.
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