Lady's Island Elementary Afterschool Registration Form (D'Arts and PUSH)

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Your child has been invited to attend either D'Arts Afterschool Program (Arts) or PUSH After School Program (Academics). Please complete these registration questions. If you need to complete a paper form, let us know and we will send one home.

Child's First Name *

Child's Last Name *

Grade Level *

How will your child get home at 4:45? *

Car rider (with tag)

Bus Rider

If bus, what address will the child be dropped off at?

If car, please skip this answer.

Parent Name *

We'll contact you for any questions/concerns during the afterschool program time.

Parent Number(s) *

Emergency Contact - Name *

Emergency Contact - Number *

Emergency Contact - Relationship to Child *

Who else is authorized to pick up your child? (Name, number, relationship) *

Are there any medical concerns or food allergies? We do not have a school nurse after hours but can provide a snack that meets specific allergy needs. *

Please check below to indicate that you're aware of the program requirements. I understand that: *

Regular attendance is necessary to ensure that my student receives the full benefit. Significant absences may result in being dropped from the program.

The program runs from 2:45-4:45 and my child must be picked up by 4:45 if a car rider. In the event that a parent or emergency contact cannot be reached, we may contact BCSO or DSS in accordance with state law in order to ensure that the child is safe.

My student must display acceptable behavior while in the program. If behavior occurs, a meeting will be scheduled to address the concerns. Significant issues may result in being dropped from the program.

Required

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