ASP Registration

Application - After School Program "Train Up!"

After School Program Registration

Student First Name *

Student Last Name *

Birthday *

Age *

School *

Grade *

Do you need school pick up for your student? Please indicate which day(s) *

Pickups Available - Elementary: (Woodrow Wilson, Cleveland, Roosevelt) Middle: (Central, Holland Woods, Ft. Gratiot)

Gender *

White/ Non White *

Parent Name *

Parent/ Guardian Phone *

Parent Email *

Student Phone

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country *

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