Kay Road Elementary After-School Program Registration   SY25-26
Please complete a registration for each individual child in your household that you would like to enroll in the After School Program. 
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School's Name *
Child's Name *
Grade level *
Custodial Parent's Name *
Phone Number *
Home Address *
Email *
Mother's Work Place Phone Number *
Father's Work Place Phone Number *
Emergency Contact Number *
Grade level *
Emergency Information: In case of an emergency, list relatives or friends in the order you wish them to be called if we can not reach you. (Please list at least 3 people.)    *
Please list below any other people who have your authorization to pick up your child. Without prior notice from you, the people listed above and below are the only ones we will release your child to. *
Please type your full name below if you have  read and understand the Peach County Elementary After School Student Handbook. *
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