CatCH Program Registration
Session 3 Offerings: January 6- February 20
(Course offering descriptions were sent in a previous email and are also available at and on Facebook at Catamount Community Hours Afterschool Program)
Email address *
Student Name and DOB *
Your answer
Grade and Teacher *
Your answer
Parent Name(s) and Phone Number (s): Cell, Work, Home *
Your answer
Emergency Contacts should Parent not be able to be reached- please complete if information has changed or not previously provided for prior sessions. (PLEASE INCLUDE: NAME, RELATIONSHIP TO CHILD, and PHONE NUMBERS) *
Your answer
Does your child have any allergies or other medical or special needs? Please Specify *
Your answer
Is your child on an IEP or 504 plan during the school day?
Is your child being provided with a one on one during the school day?
How will your child get home after programming each day? *
Please select the Monday/Wednesday course your child will participate in. (see registration packet for course descriptions)
Please select the Tuesday/Thursday course your child will participate in.
Please select if you would like your child to attend Fun Fridays during Session 3
I give permission for CatCH Program Staff to photograph/video my child during program activities or fundraisers. (Photos or videos will be displayed in our school, and may be used in flyers shared with the community, as well as in our school, local newspaper, and CatCH Facebook page) *
I give permission to CatCH Program Staff to take my child off of school grounds to participate in after school field trips. (Parents/Caregivers will be notified prior to field trip dates) *
Your answer
A copy of your responses will be emailed to the address you provided.
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