Parent's Name* First Name Last Name Parent's Phone Number* How many children are you signing up?* Child's Name* First Name Last Name Child's Grade* 1st Child's Name* First Name Last Name 1st Child's Grade* 1st Child's School* Yeshiva SchoolsHillel AcademyCommunity Day School 2nd Child's Name* First Name Last Name 2nd Child's Grade* 2nd Child's School* Yeshiva SchoolsHillel AcademyCommunity Day School 3rd Child's Name* First Name Last Name 3rd Child's Grade* 3rd Child's School* Yeshiva SchoolsHillel AcademyCommunity Day School Allergies or Dietary Restrictions* YesNo Please Explain* Which days will your child be attending?* MondayWednesday Which days will your children be attending?* MondayWednesday Emergency Contact Name* First Name Last Name Emergency Contact Phone Number* Names of people allowed to pick up your child* How did you hear about the After School Program?* Any supports your child will need when attending our after school program? Any supports your children will need when attending our after school program? Any behaviors or concerns we should be aware of while spending time with your child? Any behaviors or concerns we should be aware of while spending time with your children? Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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