CLC/After School Registration
Please fill out 1 FORM FOR EACH STUDENT you are registering for the After School Program
Email address *
Student's Name: *
Your answer
Student's Grade *
Your answer
Any know allergies or special modifications needed?
Your answer
Elementary Classroom Teacher or MS or HS *
Your answer
Program(s) your student will attend *
Required
Parent/Guardian Name *
Your answer
Phone Number *
Your answer
Will your child ride the Late bus *
If you child will use the late bus, please indicate the primary drop off address here. Include any special bus notes:
Your answer
Emergency contact/Authorized pick up name and phone number *
Your answer
Any Additional authorized pick up names and phone numbers: *
Your answer
Days we should expect your child at the after school program *
Required
Irregular schedule notes:
Your answer
Anything else the After School Staff should know about your child?
Your answer
Submit
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