Free After-School Program Admission Form Template

After-School Program Admission Form

Please complete this form to enroll your child in our after-school program and provide them with engaging, educational activities.

Student Information

Name

    Date of Birth

      Grade Level

        School Name

          Parent/Guardian Information

          Name

            Relationship to Student

              Email

                Phone number

                  Address

                    Program Details

                    Select the activities/programs you are enrolling in:

                      • Homework Assistance

                      • Arts & Crafts

                      • Sports & Recreation

                      • STEM Activities

                      • Music & Drama

                      Preferred Start Date

                        Does your child have any allergies or medical conditions we should be aware of?

                        If yes, please specify:

                          Emergency Contact

                          Name

                            Relationship

                              Phone number

                                Institution Representative

                                Parent

                                Date Today

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