After School Program Application
Completion of this form is not a guarantee of placement in the program. This program is for enrichment purposes. Students are expected to attend regularly, follow the rules and expectations of the program, and follow the rules of the school district. This is not a drop-in or childcare program.

Please fill in all information. This information is necessary for the district to provide enough staff and transportation.
1. What School ? *
2. Student Name as it appears in Skyward (full first and last) *
3. Student Grade *
4. Home address *
5. Home phone (If you have one)
6. Cell phone *
7. Parent or Guardian name(s) *
8. Emergency contact information *
9. If we go back to in-person program, and if you choose to send your student, please check ways your student is allowed to leave after the program ends *
Required
10. Name(s) of person(s) student can be released to and phone numbers of
Person(s) may be asked for identification at any time, and should be prepared to provide
11. Notes regarding transportation
12. Food allergies or health concerns *
13.Are there any other precautionary details or information the program should know about? *
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This form was created inside of Aberdeen School District No.5.