Abernethy GAP Registration
Email address *
Are you registering more than one child today? *
Please note! If you are registering multiple children you will need to complete this form once for each child.
Did your child attend the Garden Afterschool Program during the 2017-2018 school year? *
Child's Name (First and Last) *
Your answer
Child's Grade Level (Fall 2018) *
Days of the Week Requested *
Required
If your schedule request is flexible, please provide details below:
Your answer
Does your child have any allergies? *
If yes, please list your child's allergies:
Your answer
Parent and Emergency Contact Information
Parent 1 Name *
Your answer
Parent 1 Email *
Your answer
Parent 1 Phone *
Your answer
Parent 2 Name (Optional)
Your answer
Parent 2 Email (Optional)
Your answer
Parent 2 Phone (Optional)
Your answer
Emergency Contact Name (other than above) *
Your answer
Emergency Contact Phone *
Your answer
Person(s) authorized to pick up your child other than those listed above:
Your answer
Person(s) who may NEVER pick up your child:
Your answer
Authorizations and Agreements
Please read each of the following statements and check the box to indicate your understanding and agreement:
Parent or Guardian Authorization - Medication *
Required
Parent or Guardian Authorization - Medical Assistance *
Required
Garden Afterschool Program Disclaimer *
Required
Enrollment Terms *
Required
Payment Terms *
Required
Cancellation or Schedule Change Terms *
Required
Click Submit and scroll to the top of the webpage to find your confirmation.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service