Grace F3 Afterschool Program

- Wednesdays 4 pm - 5 pm
- Ms. Musgrove's office at Walnut Bend Elementary School
- 1st—5th Grade
1st and 2nd graders must be picked up unless they have an older sibling to walk them home.

Begin

press Enter ↵

Section 1

Student Information

Let's learn about your student!

What is your student's name, age, and date of birth? *

Field is required.

Back

Field is required.

Male

Field is required.

Female

Field is required.

Back

Field is required.

Is your student attending bilingual classes? *

Yes

Field is required.

No

Field is required.

Is your student in special education? *

Yes

Field is required.

No

Field is required.

Back

Field is required.

Does your student have any allergies? *

Yes

Field is required.

No

Field is required.

Does your student have any medical conditions? *

Yes

Field is required.

No

Field is required.

Back

Parent/Guardian Information

Let's learn about you as the parent/guardian.

Back

What is your name and relationship to the student? *

Field is required.

How many are in your household? *

Field is required.

Are you a single parent? *

Yes

Field is required.

No

Field is required.

Back

Field is required.

What is your email address? *

Field is required.

What is your primary contact phone number? *

Field is required.

What is your preferred method of contact? *

Field is required.

What is your preferred language? *

Field is required.

Back

Media Release

I hereby grant permission for Friends of Westchase to photograph, interview or videotape my child. It is my understanding that this photograph/interview/taping or portions thereof may be used for public view (newspaper articles, printed promotional materials, slideshows, television programs or on our website).
‍
I agree to allow my child to participate in programs run by Friends of Westchase without financial remuneration. I understand that by signing below, I release any photographer, interviewer, or Friends of Westchase volunteer or staff person from any future claims, as well as from any liability arising from the use of said interview, photograph, video or printed material.

Back

Sign

press Enter ↵

Field is required.

Inputting your name above acknowledges a legally binding agreement.

Today's date *

Field is required.

Back

Proceed

Section 4

Consent to Release

Please review and sign one of the following:

Walk Home

Field is required.

Pick Up

Field is required.

Permission for Pick Up

I give permission for my child to be picked up after the Grace F3 Program. I understand that Friends of Westchase will not be held responsible for any accidents that may occur when my child leaves the program premises. I understand that my child will be picked up, only with my written consent. By signing this form, I release Friends of Westchase, its staff, and volunteers from all liabilities.

Back

Sign

Field is required.

Inputting your name above acknowledges a legally binding agreement.

Today's date *

Field is required.