2018-2019 School Year Whitko After School Central (ASC) Permission Form
Find us on the web thecentercc.com
For Questions, Contact: Shawna Miller - Program Director
shawna@thecentercc.com or (260) 248-4977
Household/Family Information
Primary Adult Contact First Name *
Your answer
Primary Adult Contact Last Name *
Your answer
Relationship to Student *
Please Select all that apply *
Required
Primary Contact Street Address *
Your answer
City *
Zip Code *
Phone *
Your answer
Email Address *
Your answer
What is the best way to contact you? *
Would you like to add a second adult contact? *
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