ABS Before & After School Registration Form
Please read the ABS Before & After School Care Handbook BEFORE filling out this registration form.


Fill out one form per child.

Child's Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Grade level for 2018-2019 *
Parent's Name(s) *
Your answer
Parent's Phone Number(s) *
Your answer
Parent's Email(s) *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Parent 1 place of work *
Your answer
Parent 1 work phone *
Your answer
Parent 2 place of work *
Your answer
Parent 2 work phone *
Your answer
Emergency contact name and phone number (other than parent) *
Your answer
Authorized Pick-Up List - List full name and relationship to your child of those who have permission to pickup your child from the Arts Based Before & After School Care Program. *
Your answer
Please list any student limitations or health concerns we need to know about: *
Your answer
Please list any allergies to food or medication your child may have. (explain reaction to exposure) *
Your answer
Please list any medication your child will need to take during Before & After School Care. *
Your answer
To submit the registration form, you must read the ABS Before & After School Care Program Handbook and check the box below. *
Required
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