Student Registration

Step 1 of 3

First Name(Required)

Last Name(Required)

District(Required)

School(Required)

Grade(Required)

Gender(Required)

DOB(Required)

Program Choice(Required)

Program Code

Does the student currently attend the school provided After School Program?(Required)

Yes

Does the student currently receive any Special Education services? (Speech, Academic Support, Counseling, etc.)(Required)

Yes

If YES to any of the above, please provide details regarding the student’s special education services, accommodations, and/or school site heath plan.

Student Lives With(Required)

First Name(Required)

Last Name(Required)

First Name(Required)

Last Name(Required)