After School Program Sign-Up 24/25 SY
*WAITLIST ONLY-We have reached capacity!

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This program is for currently enrolled students, and is offered at $20 per student each Wednesday, with a maximum charge of $50 per Family. This form will need to be filled out for each student you want considered for the program. The After school program is only available on Wednesdays from 1pm-4pm. This fee includes adult supervision, activities and snack. There is no transportation provided for students participating in After School and Parents/Guardians are expected to pick their student(s) up by 4pm. Late fees may be applied for pickups after 4pm. Your student(s) will need to be signed out by an adult listed on their dismissal record each Wednesday they attend. After school will begin on September 18th. We have very limited availability for this program, completing this form DOES NOT GUARANTEE acceptance. You will be contacted via email and/or class dojo if your student is selected by September 10th. 

*Your student(s) CAN BE DROPPED from the program for non attendance, behavior, non payment or punctuality concerns in regards to picking up your student(s).
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Email *
Student First Name *
Student Last Name *
Student Grade Level *
Parent/Guardian First AND Last Name *
Parent/Guardian Cell Number ex. 612-333-3333 *
Emergency Contact First AND Last Name *
Emergency Contact Cell Number ex. 612-333-3333 *
How will you be paying? *
Questions/Comments
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