Enroll for Before School Program

Before School Program Enrollment Form

Guardian Email 

Name of Student 





Grade Level of Student 


Guardian's Name 

Full Address 

1st Phone # 

2nd Phone # 


Names and phone #'s of people who can pick my child up from program 


I'm signing up for the

 Before School Program

 After School Program


Medical Concerns

 My child has health concerns, please contact the school nurse

 My child does not have any health concerns


I agree to the following (check all that you agree to)

 Provide proof of free or reduced fees from school district for a reduction in fees.

 I also give the After School Program permission to take my child off school property.

 $15 family enrollment fee, with payment of monthly fees by the 10th of each month.


 I cannot agree and will visit with Mr. Brown about my concerns.


Other Siblings in the Program 


By signing, I am agreeing to the terms of attendance for the after school program.

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