After School Registration
Please fill out the following form. After School will begin Sept 17th. Floating Open House will be Sept. 14th from 3pm-5pm.
Student 's Name (first & last)
What school does your student attend?
Down East Middle/Smyrna Elementary
Harkers Island Elementary
Grade is your student going into?
What is your address?
What is your students date of birth?
Will your child need transportation?
No, I will be taking my child to and from the program
Yes, I need my child to be either picked up, brought home, or both
I don't know yet
Does your child receive special education services?
Does your child have any allergies?
List any one who is allowed to pick up your child. Please list your relationship with the person. (ex: John Doe - Family Friend)
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