Ladysmith Elementary School After School Program Registration
The Ladysmith Elementary School will once again be offering its Early Risers and After School Program starting October 7, 2019. The Early Risers Program will run from 7:25-8:10 am Monday thru Thursdays and the After School Program will run from 3:45-5:45 pm Monday thru Thursday. If you have questions on the program of this registration form please contact the program director, Kirk Yudes, by email at KYudes@sdlwi.org
Email address *
Last Name *
Your answer
First Name *
Your answer
Date of Birth *
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DD
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Gender *
Ethnicity *
Primary Language *
Complete Address *
Your answer
Phone *
Your answer
Parent Email *
Your answer
School *
Your answer
Grade *
Homeroom Teacher *
Your answer
Math Teacher *
Your answer
Literacy(English) Teacher *
Your answer
Student Resides with *
Transportation Home *
Special Needs (Allergies, Medications, Diet, etc.) *
Your answer
Parent/Guardian Last Name, First Name (If Multiple Please list All) *
Your answer
Parent/Guardian Home Phone *
Your answer
Parent/Guardian Work Phone *
Your answer
Relationship to Student *
Your answer
Please List Emergency Contact Last Name, First Name and Relationship to the student *
Your answer
Emergency Contact Address *
Your answer
Emergency Contact Home Phone *
Your answer
Emergency Contact Work Phone *
Your answer
List Any Authorized People who can pick up your student followed by their phone number please: *
Your answer
Please List anyone NOT authorized to pick up your student(s) Last Name, First Name:
Your answer
Electronic Signature certifying that you certify that you have read and do understand the above information: *
Your answer
A copy of your responses will be emailed to the address you provided.
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