Afterschool Program Application

You can view, download or print our Afterschool Program Application below:

PDF Version here:


Applicant Information

Applicant Information

In case of an emergency, notify: (List contact information for hours during Day Care -for example work address and phone if at work)

Names of individuals authorized to pick up child who are NOT listed above:

Health Information

The following information must be filled in by the parent/guardian. The intent of this information is to provide staff the background to provide appropriate care. Provide complete information so that we can be aware of your child's needs.

Allergies / Describe reaction and management of the reaction