AFTER-SCHOOL PROGRAM REGISTRATION

AFTER-SCHOOL PROGRAM REGISTRATION

WETHERINGTON UNIT- EL DORADO - 1401 E CENTER ST.
NOTE: All children must have a 2021 membership application on file. Children MUST be K-12th grade during the 2021-2022 school year to qualify for registration.
MEMBER INFORMATION
Member Name *
Age *
Date of Birth (MM-DD-YYYY) *
Gender (Male/Female) *
Grade (2021-2022 School Year) *
School (2021-2022 School Year) *
PARENT/GUARDIAN INFORMATION
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Emergency Contact Name *
Emergency Contact Number *
Please enter a valid phone number.
After-School Program Payment

NOTE: No refunds will be given for unattended semesters or behavioral removal. Payment can be made by semester but Fall Semester must be paid at the time of registration to hold your child's spot.

Choose what semester your child(ren) will be attending *

Fall Semester

$ 20.00 Children

Spring Semester

$ 20.00 Children

Total

$ 0.00

MEMBER INFORMATION