Application for After-school Enrollment Please provide the following information about your child for Oakhurst's after-school care. This program is for elementary age children up to age 12 and provides care after school and on no-school days during the school year. Child's name * Date of birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201220132014201520162017201820192020202120222023202420252026 Gender * Yes No Main e-mail for parents/guardians Parent or guardian #1's name * Phone number * Relationship to child * Parent or guardian #2's name Phone number Relationship to child Does the child live at more than one address weekly? (Example: Shared Custody) * Yes No Please list any food allergies Does your child have any special needs? Understanding these needs will help us better care for your child. Will they need a bus ride? * Yes No Does your family qualify for assistance with tuition through Connect or Link Resource and Referral? * Yes No If unsure, please contact Connect (Kanawha County) at 304.414.4488 or Link (Putnam County) at 304.523.9540. Tell us about your child's personality * Do you need all-day care through the week if school is closed? * Yes No Will you need full care in the summer? * Yes No Does your child have siblings who attend Oakhurst presently, or in the past? * Yes No If yes, please list their names
