After School Care Registration Form

After School Care Registration Use

2025-2026 School Year

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Family Last Name*
MM slash DD slash YYYY
Please check the box ONLY if you intend to use ASC on an as needed basis.
Please remember: Reservations and payment should be made by Thursday of the week before care is needed.
Student Information*
Use the (+) symbol to add multiple names. Please indicate the days that each student will regularly attend ASC. You may type the following abbreviations in the box: M – Monday, T – Tuesday, W – Wednesday, H – Thursday, F – Friday.
Name
Grade
Days attending
Approx. Pick-Up Time
 
This may include details related to allergies, custody arrangements, etc.
Approved Pick Up List*
Please provide the names of all people (PARENTS INCLUDED) who may pick up this child/these children from After School Care. Use the (+) symbol to add multiple names.
Name
Relationship
Cell Phone Number