After School Application Child's Name * First Name Last Name Birth Date * MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Allergies * Parents Information Parent 1 Name * First Name Last Name Relationship * Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Parent 2 Name First Name Last Name Relationship Email Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name * First Name Last Name Phone * (###) ### #### Email Program Which program do you wish to enroll your child? K-Culture (Tuesday) Art with the Masters (Wednesday) Basic Cooking (Thursday) Ceramic (Friday) Wednesday program only: I wish to have my child picked up at Compass Charter School * Yes No How did you hear about us? Instagram/Facebook Event Friend/Colleague Email Thank you!
