After School Registration

After School Program

Address*

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What days will your child be attending:*

Does your child have any allergies?*

Do any of these allergies require an epipen?

If yes, do you give permission for us to administer the epipen if needed?

Do we have permission to give the following if needed:

Tylenol/Acetaminophen*

Advil/Motrin/Ibuprofen*

Antacid*

Benadryl*

Hydrocortisone*

Neosporin/Triple Antibiotic ointment*

Do you give permission for us to give basic first aid as needed?*