Raven Wolf Afterschool On line Registration Form

Raven Wolf Afterschool Program at Nevada City School of the Arts

To register your child for Raven Wolf afterschool please fill out the form below and submit.

Childs Name*
First Last
Birth Date*
Grade*
1st Parent/Guardian Information:
Parent Name
First Last
Relationship
Email
Cell Phone
Work Phone
Home Phone
2nd Parent/Guardian Information:
Parent Name
First Last
Relationship
Email
Cell Phone
Home Phone
Work Phone
Who should first be contacted in an emergency?
Name
First Last
Phone
** If applicable, what is the custody arrangement for this child?
Custody arrangement
Billing Name & Address:
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Authorized Pick-Ups
Your child will only be released to the Parents/Guardians listed on this application, and the following persons (this can include an older sibling at NCSA). Please write any possibilities that may occur (aunts, neighbors, etc).
Please list below Authorized Pick-Ups
Name:________ Relationship: _________ Phone:_____
** Does your child have any allergies or dietary concerns we should be aware of?
Please sign below
Signature

For further information or questions, contact Kim Bailey @ 273-7736 x319 or by email: kim.bailey@ncsota.org