Cherokee PTA After School Program Registration
We're sorry--Fall registration is now closed.
Grade/Homeroom Teacher *
Course Selection
Release Information
Release Option *
Spouse's Name
Your answer
Spouse's Phone Number
Your answer
Adult #1
Enter the name of another adult who is permitted to pick up your child in addition to your spouse.
Your answer
Adult #1 Phone
Enter the phone number of adult #1.
Your answer
Adult #2
Enter the name of second adult who is permitted to pick up your child.
Your answer
Adult #2 Phone
Enter the phone number of adult #2.
Your answer
Emergency Information
Please be aware that any medications stored in the nurses office at school may not be available during after school classes. If your child has a medical issue that potentially requires urgent access to medications, please make a plan with your after school instructor.
Responsible Party
Your answer
Insurance Company
Your answer
Dentist
Your answer
Dentist's Phone Number
Your answer
Doctor
Your answer
Doctor's Phone Number
Your answer
Preferred Hospital
Your answer
Medical Treatment *
In case of emergency, do you CONSENT or DENY medical treatment and transportation for your child?
Your answer
Other Information
Facts concerning the child's medical history, including allergies, medications being taken, and any physical or learning issues to which a physician or instructor should be alerted may be included here.
Your answer
Release and Acceptance
Policy Acceptance *
Policies of the Cherokee PTA After School Program may be found here: https://sites.google.com/site/afterschoolcheetahs/home/policies
Required
Permission to remain after school *
If you check this box, you grant the Cherokee After School Program and Cherokee staff to accept your permission electronically for your child to remain after school on the days they have after school programs. This replaces the requirement for parents to send in a signed paper permission form.
Required
PLEASE TYPE YOUR NAME INTO THE BOX BELOW. BY CHECKING THE "CONFIRM E-SIGNATURE" BOX, YOU ARE VERIFYING THAT YOU ARE THE PARENT AND/OR LEGAL GUARDIAN OF THE ABOVE MENTIONED STUDENT AND AGREE TO THE ABOVE MENTIONED TERMS *
Your answer
*
Required
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