2024-2025 After School Kids club
Monday-Friday from 3pm-6pm.
Sign in to Google to save your progress. Learn more
Student Name *
Student Grade *
Days Per Week - mark all that apply
Will Attend
until 4pm
until 5pm
until 6pm
Only on occasion
Monday
Tuesday
Wednesday
Thursday
Friday
Mother's Name
Mother's Cell
Father's Name
Father's Cell
Family Physician's Name and Phone
Family Dentist Name and Phone
Please list any other phone numbers where you can be reached in case of an emergency
If there is anything pertinent to your child's care that we should know?
Does your student have any known allergies? Please give any pertinent information.
Students will only be released to individuals listed on the student release.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Santiam Christian Schools.

Does this form look suspicious? Report

Google Forms