After School Sign Up Sheet
In order for your child to attend the after school program this form must be filled out and payment must be received by 5:00pm on Friday of the previous week for your child to attend the next week. Payment is to be made online only and after signing your student up, you will be redirected to the payment screen. If you have multiple students attending please fill out a form for each child. A form needs to be filled out and payment needs to be made each week. Any questions, feel free to email Miss Simon at
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Email *
Student First and Last Name: *
Grade Level: *
Subject/Subjects your child needs help in: *
What week will your child be attending? *
What days will your child be attending this week? *
Parent Name: *
Emergency Contact Name and Phone Number: *
Student pick up procedure: *
Sign up/ Payment Procedure *
A copy of your responses will be emailed to the address you provided.
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