Chicago West Side Christian School
After-School Program Registration
20122013
Student Name: ___________________________________________ Grade: ______________
Parent Name: ____________________________________________ Phone: ______________
Please circle which days of the week your child will participate in the after-school program
M
T
W
Th.
F
On average, what time will your child be picked up from the after-school program?
4:00
4:30
5:00
5:30
6:00
Please list any allergies or other concerns that the after-school staff should know about:
Please initial before the following statements to show your agreement:
_____ I understand that there is a $2.50/hour fee associated with the after-school program.
_____ I understand that I must pre-pay each month for after school care in the school office.
_____ I understand that I must sign my child out from the school office each day at pick-up.
_____ I understand that I must pick up my child no later than 6 p.m. daily.
_____ I understand that some enrichment clubs require a multi-day commitment (Running Club &
Drama Club)
_____ I understand that I also must complete a separate registration form in order for my child to
participate in Enrichment Clubs (3:40-4:30), but there will be NO additional fees for the club
since my child is registered for the after-school program.
Parent Signature: ____________________________________________ Date: _________________
CWSCS 2012-2013