Child Information

I am interested in registering for the After Care program. Upon registration, I understand an account will be setup and a registration fee of $50 per student will be billed to my account. BEFORE CARE WILL NOT BE AVAILABLE UNTIL FURTHER NOTICE DUE TO COVID-19.

Child's First Name

Child's Last Name

Child's Grade and Teacher

Before Care Information

BEFORE CARE WILL NOT BE AVAILABLE UNTIL FURTHER NOTICE DUE TO COVID-19. I will be using the Before Care program for the following:

Please indicate all days of the week that apply.

	Yes
Monday	Yes
Tuesday	Yes
Wednesday	Yes
Thursday	Yes
Friday	Yes

After Care Information

I will be using the After Care program for the following:

Please indicate all days of the week that apply.

	Yes
Monday	Yes
Tuesday	Yes
Wednesday	Yes
Thursday	Yes
Friday	Yes

I will be using the After Care program during the sport's season

Please indicate all sports that apply.

	Yes
Baseball	Yes
Basketball	Yes
Cheerleading	Yes
Cross Country	Yes
Fastpitch Softball	Yes
Football	Yes
Track	Yes
Volleyball	Yes
Wrestling	Yes

Adults and/or coaches authorized to pick up and sign my child out of NDES After Care Program. (We realize you may not know your winter/spring coaches. When that information becomes available or information changes, please update the office.)

	First Name	Last Name
#1	First Name	Last Name
#2	First Name	Last Name
#3	First Name	Last Name
#4	First Name	Last Name

Other Information

The Before and After Care program will use the Emergency Medical Authorization information supplied on the Back-to-School form.

Contact Information

First Name *

Last Name *

Phone Number *

Email Address for billing statements *