2017 CFC 4-H Afterschool Summer Program Registration
Students in Grades K-6 during 2017-18 school year
June 5 to August 25, 2017
Monday – Friday
7:00 a.m. – 6:00 p.m.

Students must bring their own sack lunch each day. Morning and afternoon snacks are provided. Families are required to provide some snacks and supplies for the program. 4-H Afterschool summer staff is youth protection certified trained college and high school students. Students are encouraged to participate in the CFC School District’s summer school. All bus field trips are available to students at NO additional cost. All 4-H Afterschool summer students will also enroll in Buffalo County 4-H and enter exhibits at the Buffalo County Fair – fair fees are included in registration.

In order to finalize 4-H Afterschool Summer registration, a deposit per student equal to one week’s fees must be sent to UWEX by March 1, 2017. This deposit is nonrefundable after March 1, 2017. The deposit will be applied to the last week of participation in 4-H Afterschool Summer Program. A $5 4-H enrollment fee for insurance is also required once per academic year. Please send checks only made payable to 4-H Afterschool to: 4 H Afterschool, Buffalo County UW-Extension, PO Box 276, Alma, WI 54610 or send to school with your child in a sealed envelope marked 4-H Afterschool.


Rates Per Child Each Additional Child
Full time (4 or 5 days per week) $100/week $80/week
Part time (3 days per week) $75/week $60/week
Part time (1 or 2 days per week) $30/day $25/day

Parent/Guardian Name
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Contact Phone for Registration Purposes
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Contact Email for Registration Purposes
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Student First and Last Name
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Student Current Grade
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How many days a week will your child participate in 4-H Afterschool this summer?
Check the days of the week your child will attend.
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Estimated Time of Arrival Each Day
Time
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Estimated Time of Departure Each Day
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Please include any comments or additional information 4-H Afterschool should know about your registration.
If you would like to request a partial scholarship, payment plan or request for reduced rates, please explain your need for financial support in 2-3 brief sentences below. Thank you.
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4-H Afterschool Summer Program Contract -- READ THE FINE PRINT PLEASE
Check each box to signify that you have read each item in the contract.
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Signature
Please type your full legal name in the text box below. This will certify as your legal signature.
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