Pirate Out-of-School Time
This form is a REGISTRATION FORM for middle school students, grades 5-8. This is NOT an application; we accept all students who are registered. Upon completion of this form, your student is enrolled in the POST After School Program and will be able to participate from the beginning of programming, September 8th. 
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Student Name *
Date of Birth *
MM
/
DD
/
YYYY
Sex *
Race *
Father/Guardian Name *
Mother/Guardian Name *
Parent/Guardian 
Address, City, State, Zip
Home or Cell Phone *
Father's Work Information
Employer, Work Phone, Work Hours
 *
Mother's Work Information
Employer, Work Phone, Work Hours
 *
Special Ed? *
Limited English? *
Grade *
New to the School District? *
My child will participate in the following extracurricular activities during the 2025-2026 school year.  I understand this will not hinder their participating in the 21stCCLC After School Program.
For transportation, my child will be a *
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