Extracurricular Class Registration Form

Name

First NameLast Name

Grade Level

Advisory Teacher

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

In case of emergency, the Parent/Guardian will be contacted based on the information below:

Name

First NameLast Name

Primary Phone Number

Format: (000) 000-0000.

Secondary Phone Number

Format: (000) 000-0000.

Email

example@example.com

REMINDER: You can only select 1 activity per day and students can only join 3 extracurricular activities.

Monday

Tuesday

Wednesday

Thursday

Friday

Extracurricular Activities

Students can only join a maximum of 3 activities.

$49.00How many activities will the child participate to?

Total

Does the child currently committed to activities outside school?

If yes, please list them below:

REMINDERS:

If the student will participate in these activities, they should still meet the school standards in terms of behavior, attitude, and scores.
Students who registered in these activities must attend these programs as per schedule.
A waiver from parent/guardian is needed to complete this registration.

Parent/Guardian Signature

Date Signed

Date

Student Information