Pirate Quest Application
Please fill out the form completely.  Anything that is left out can disqualify a student from participation in Pirate Quest. Your application will be checked for qualifying criteria. Openings will be filled on a first come basis, so if your child qualifies for Pirate Quest or FACES, you will be notified by August 5, 2022.  If your child qualifies for Pirate Quest but your application is received after all spots have been filled, your child will be placed on a waiting list.  As students leave the program, Pirate Quest will replace with those on the waiting list.
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Email *
Which After School Program Site? *
Student's Last Name *
Student's First Name *
Gender *
Required
Race/Ethnicity *
What grade is your student in? *
Parent's name *
Address *
Phone Number *
Do you have transportation? *
Does your child have any allergies? *
Does your child take medication? *
Emergency Contact Name *
Emergency Contact Phone Number *
I give permission for my child’s photo or video to be used on the social media site, flyers, and other publicity materials. *
I understand that if my child does not attend Pirate Quest on a regular basis and misses more than two weeks total, he/she will be taken out of the program. *
If my child does not qualify for Pirate Quest he/she will be offered a spot in the FACES(PreK-4th grade) program with a fee of $5.00 a day per child. Discount available for more than one child. I would like a spot for my child/children. *
Child/Children's Name and Grade *
A copy of your responses will be emailed to the address you provided.
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