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After School Enrichment Identification and Emergency Form

Please complete the form below. Required fields marked with an asterisk *

Identification and Emergency Information 

Student Information

Gender *
Answer Required

Parent/Guardian #1 Information

Parent/Guardian #2 Information

Children will not be allowed to leave with any other person without authorization from main parent/guardian. The person picking up the child with have to show proper identification. If there are added persons who is not on the orignal form given - the parent/guardian will recieve a phone call confirming the change/add.