AfterSchoolLife

Please fill out one from for each student you wish to enroll.

All information is kept completely confidential and is for After School Life's internal use ONLY.

Session

Day 1

Day 2

Day 3

Day 4

Day 5

First name

Last name

Age

Grade

Pickup

Address

City

State

Zip

First Name

Guardian last name

Guardian phone

Guardian cell

Guardian email

Emergency contact

Emergency relationship

Emergency phone

Allergies, Medical Conditions, Medications

Comments

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