Afterschool Registration Form

Parent's Email: *

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Date and time *

Student's Home Room Teacher *

I approve of this Parent/Guardian authorization. Signature required to process this registration *

Yes

No

Address 2

Select The School Program of Your Choice *

Oakland Terrace FALL 2022 - Thursdays 3:30-4:30pm - 8 clinics: 10/06, 10/13, 10/20, 10/27, 11/03, 11/10, 11/17, 12/01

Oakland Terrace WINTER 2023 - Thursdays 3:30-4:30pm - 8 clinics: 1/19, 1/26, 2/02, 2/9, 2/16, 2/23, 3/02, 3/9

Oakland Terrace SPRING 2023 - Thursdays 3:30-4:30pm - 8 clinics: 3/30, 4/13, 4/20, 4/27. 5/04, 5/11, 5/18, 6/1

I am the legal guardian / custodial parent *

Yes

No

Parent's Name *

Persons authorized to pick up student *

Student's School *

Student's Grade *

Student's First Name *

Electronic Signature *

Student's Last Name *

Phone *

Student's Gender

Female

Male

Other

Address *

Emergency Number *

How did you hear about this SPDBasketball activity?

Zip Code *