Aftercare Survey -

Hidden

Created Date

Parent/Guardian Name(Required)

First Last

Parent/Guardian Email(Required)

Phone(Required)

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Student Name(Required)

First Last

Select Grade(Required)

Pronouns

Birthday(Required)

	Monday	Tuesday	Wednesday	Thursday	Friday
Aftercare Only 3-4:15PM ($20 per day)
Aftercare Only 3-5PM ($35 per day)
Aftercare Coverage before or after an Afterschool Class ($15 per day)

survey choices