Name of Student (required)
Grade (required)
Name of School (required)
Teacher (required)
Parent/Guardian Name (required)
Phone (required)
Your Email (required)
Emergency Contact (required)
I understand that enrichment classes are a privilege. I will take responsibility to have respectful behavior and consistent attendance in all After-School Enrichment Program Classes. I understand that if I miss more than two classes or misbehave, I will be asked to leave the classes and another student will replace my spot. I understand that I will not receive a refund for the cost of the class.
Parent or Legal Guardian Signature: (required)
Name of Parent or Legal Guardian Signature:(required)
Date of Signature: (required)
Student/Participant Signature: (required)
Student/Participant Signature:(required)
After my class:
The child is being picked up by a parent
By an authorized 3rd person. (the parent must specify the name and relationship such as: "My child will be picked up by the babysitter (Ms. XYZ or Ms. XYZ)
My child is being picked up by a grandparent Ms/Mr XYZ)
My child will walk home.
My child will go to 4R
Base or the schools supervised extension room.
If I fall to do so, my child will be dropped from the Enrichment class.
I understand that I must pick up my student promptly at 3 pm.
Does your child have any allergies?
No Yes
Please list out.
If there is a fee, send your child with cash payable to Two Rivers PTA in a sealed envelope at sign up.
