Extracurricular Class Registration Form

Name

First NameLast Name

Grade Level

Advisory Teacher

Email

example@example.com

Phone Number

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

Secondary Phone Number

Email

example@example.com

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

Monday

Glee Club (4:00pm-5:00pm)Basketball (4:15pm-5:15pm)Gymnastics (4:30pm-5:30pm)

Tuesday

Acting Club (4:00pm-5:00pm)Volleyball (4:15pm-5:15pm)Home Economics (4:30pm-5:30pm)

Wednesday

Music Club (4:00pm-5:00pm)Tennis (4:15pm-5:15pm)Debate (4:30pm-5:30pm)

Thursday

Art Club (4:00pm-5:00pm)Chess (4:15pm-5:15pm)Computer Club (4:30pm-5:30pm)

Friday

Dance Club (4:00pm-5:00pm)Badminton (4:15pm-5:15pm)Quiz Bee Club (4:30pm-5:30pm)

Registration Fee

Extracurricular ActivitiesStudents can only join a maximum of 3 activities.

$49.00How many activities will the child participate to?

Total

$0.00

Does the child currently committed to activities outside school?

YesNo

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