Wenham After School Care Registration

Please list all names and telephone numbers of parents/guardians and phone numbers where they can be reached at any time.

1st Parent/Guardian Name *

Cell Phone Number

Work Phone Number

Home Phone Number

2nd Parent/Guardian Name

Cell Phone Number

Work Phone Number

Home Phone Number

Child's Name and Grade *

Child's Name and Grade

Allergies/Medical Conditions, Additional Notes

Indicate below which days your student(s) will have a regular ASC schedule.

Day of the week

Monday Tuesday Wednesday Thursday Friday

Please list the anticipated pick-up time for each regularly scheduled day your student will attend ASC

NOTE: After School Care Staff will have access to Student Health and Emergency Information.

Monthly bills for After School Care will be directly billed by FACTS.