After-School Programs Enrollment Form

Schools and educational centers use this form to register students for after-school programs and collect the contact and health details they need.

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Participant's Information

First Name

Last Name

Date of Birth

Name of the School the Student Currently Attends

Teacher's Name or Classroom #

Has your child been diagnosed with a medical condition or disability you'd like to share with us?

Guardian

First Name

Last Name

Relationship to Student

Best Contact Number

Email

Address

Street Address

City

State / Province

ZIP / Postal Code

Choose the Program(s) of Interest

I allow my child to be photographed or filmed for the program's promotional purposes

Yes, I authorize

Date

Parent or Guardian Signature

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