After School Sign Up Sheet

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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 asimon@wolcottschool.com

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? *

Tuesday, Wednesday and Thursday

Tuesday

Wednesday

Thursday

Required

Parent Name: *

Emergency Contact Name and Phone Number: *

Student pick up procedure: *

By checking this box, I understand that my child needs to be picked up at 5:30 on after school days by the front office. Failure to pick up my child at 5:30 will result in my child not being able to attend the after school care program.

Required

By checking this box, I understand that my child needs to be signed up and paid by 3:00pm the Friday before the next week in order to attend the after school program for the next week.

Required

A copy of your responses will be emailed to the address you provided.

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