IGNITE Before & After School Program Registration
If you have more than one scholar, please complete a separate form for each scholar.
Which program will your scholar be participating in: *
Required
Scholar Name: *
Your answer
Scholar Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip Code: *
Your answer
Parent/Guardian's Name: *
Your answer
Parent/Guardian's Address: *
If different from the scholar's address listed above
Your answer
Parent/Guardian's Preferred Phone Number: *
Your answer
Scholar's Grade: *
Scholar's Homeroom Teacher:
Your answer
Preferred Email Address: *
Your answer
Emergency Contact: *
Your answer
Emergency Contact's Phone Number: *
Your answer
Emergency Contact's Relationship to Child: *
Your answer
ALL Persons Authorized to Pick-Up Scholars (other than parent/guardian listed above): *
Please include all names, phone numbers and relationship with the child. Photo ID will be required for pick-up.
Your answer
Please list any allergies and/or health or medical concerns that IGNITE staff should be aware of: *
If there are no concerns, answer with none.
Your answer
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