AFTERSCHOOL PERMISSION SLIP [Session 1] 
Please complete this form to give permission for your scholar to remain after school for one of the listed programs.
Make sure to indicate both a 1st ,2nd, & 3rd choice in case options are full.
All information will be used for contact and emergency purposes only.
Email *
1. Parent/Guardian Name
 *
2. Scholar’s Name
 *

Primary Contact for Pick-up (Name)

 *
Phone Number: *

Secondary Pick up contact (Name)

 *

Phone Number:

 *
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