Please fill out the following form before your child's first day of afterschool classes.

Location Attending: *
Which location is your child attending our classes:
Student's Name *
Student's Name
Birth Date *
Birth Date
Address *
Address
Which room/ area of the school do we meet your child with their teacher?
Parent/Guardian Name: *
Parent/Guardian Name:
Cell Phone
Cell Phone
Home Phone
Home Phone
Work Phone
Work Phone
Parent/Guardian Name
Parent/Guardian Name
Cell
Cell
Work
Work
Address (if different from above)
Address (if different from above)
Emergncy Contact / Authroized for Pick Up
Emergncy Contact / Authroized for Pick Up
Contact Number
Contact Number
Emergency Contact / Authorized for Pick Up
Emergency Contact / Authorized for Pick Up
Contact Number
Contact Number
Please add additional names and phone numbers of adults you would like to authorize for pick up at Sprouts or Sprouts Maker Space.
Waiver Forms *
Please check each waiver to agree.
Please inform us of any other information you think we may need to know.
Request End of Day Walk from Maker Space to Sprouts
If you have a child at Maker Space and they have a sibling at Sprouts, or if you prefer to pick up at Sprouts, we can walk them down to 183 Carlaw at 5:45 (arriving approx 5:55/6pm) Please check the following box if you would like your child to be walked to 183 Carlaw Ave. by 6pm.
I hereby certify that all the information given regarding my child's registration is deeped complete and accurate.
Date *
Date