Capitol Heights Middle School 21st CCLC FREE After School Program Sign Up Form.
Please Note: This program is for 6th, 7th, and 8th grade students who attend CHMS. If you are registering more than one child, then please complete a separate form for each child.
The program will begin on the week of January 11th, 2021, will be from 2:30 until 4:30 from Monday through Thursday after school, and will run for 87 days. The first week of May will be our tentative schedule showcase.
THIS FORM MUST BE COMPLETED BY THE CHILD'S PARENT/GUARDIAN.
* Required
Student Name
*
Your answer
Student Current Grade
*
6th
7th
8th
Student Date of Birth
*
MM
/
DD
/
YYYY
My child is interested in the following enrichment activities: (You may choose more than one)
*
Robots and Coding
Graphics Design
Business and Entrepreneurship
Dance
Instrumental Music
Vocal Music
Music Beats (Tracks/Pro Logic)
Theater/Musicals
Required
Parent/Guardian Name
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Parent/Guardian Email
*
Your answer
Emergency Contact Person
*
Your answer
Emergency Contact Person Phone Number
*
Your answer
My child may be picked up by the following people:
Your answer
By clicking on the check box, then I am electronically signing this form and agreeing to let my child participate in the Capitol Heights Middle School 21st CCLC after school enrichment program
*
YES
Required
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