After-School Program Preferences Questionnaire
Help us tailor our after-school programs to best fit your child's needs and interests.
Parent/Guardian Full Name
*
First Name
Last Name
Child's Full Name
*
First Name
Last Name
Child's Grade Level
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which days of the week would you prefer your child to attend the program?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Other
Preferred Program Time
*
3:00 PM – 5:00 PM
4:00 PM – 6:00 PM
No preference
Other
Which activities is your child interested in? (Select all that apply)
*
Homework Help
Arts & Crafts
Sports & Physical Activities
Music & Performing Arts
STEM (Science, Technology, Engineering, Math)
Reading/Book Club
Other
Does your child have any allergies, medical conditions, or special needs we should be aware of? If yes, please specify.
Will your child need transportation to or from the program?
*
Yes, both drop-off and pick-up needed
Only drop-off needed
Only pick-up needed
No transportation needed
Emergency Contact Name and Phone Number
*
Please provide any additional comments or suggestions to help us improve our after-school program.
Submit Preferences
Should be Empty: