School Break Availability Form
Let us know your student's availability and preferences for upcoming school breaks.
Student's Full Name
*
First Name
Last Name
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student's Grade
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
Which school break(s) does your student need care or activities for?
*
Spring Break
Summer Break
Winter Break
Other
Days of the week available during the break
*
Monday
Tuesday
Wednesday
Thursday
Friday
Not sure yet
Preferred times during the day
*
Morning (8am - 12pm)
Afternoon (12pm - 4pm)
Full Day (8am - 4pm)
Other
Preferred activities for your student
Arts & Crafts
Sports & Games
STEM/Science Projects
Reading/Library Time
Outdoor Activities
Other
Does your student require supervision or care during the break?
*
Yes
No
Not sure
Does your student have any allergies or medical needs?
*
No
Yes (please specify below)
If yes, please specify allergies or medical needs
Will your student need transportation to/from the program?
Yes
No
Maybe
Additional comments or information
Submit
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