2023-24 Afterschool Pre-Registration Form This years Afterschool Program begins Tuesday, September 5th 2023! Please enable JavaScript in your browser to complete this form.Fall Session: Grades 1-5Please note that completing this form puts your child on the waitlist, and does not automatically enroll your child in the program. A Funhouse staff member will contact you within 5 business days to confirm availability for the days you would like to register.Please select the days you'd like your child(ren) to attend: *MondaysTuesdaysWednesdaysThursdaysFridaysRequested Afterschool start date: *Participant DetailsHow many participants are you registering today? *-123Participant Name *FirstLastAge *Date of Birth *Grade *-12345School *Orcas Island ElementaryOrcas Christian SchoolSalmonberryOasisOther (please specify in notes below)Participant 2 - Name *FirstLastAge *Date of Birth *Grade *-12345School *Orcas Island ElementaryOrcas Christian SchoolSalmonberryOasisOther (please specify in notes below)Participant 3 - Name *FirstLastAge *Date of Birth *Grade *-12345School *Orcas Island ElementaryOrcas Christian SchoolSalmonberryOasisOther (please specify in notes below)Contact InformationName of Parent/Guardian *FirstLastWhat is your relationship to the participant? *Phone *Email *Physical Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOn-Island Emergency Contact *FirstLastEmergency Contact Phone *Is this your first time signing up for Funhouse programs? *YesNoPlease list the first and last names of anyone who has permission to pick up your child/children up at The Funhouse: *If there is anyone who you DO NOT ALLOW to pick up your child/children, please list them here: *Will you need a scholarship to help pay for Afterschool Program costs?YesNoIs there anything else you'd like us to know?By signing this form, I declare that I am the legal parent/guardian of the minor child listed above and authorized to grant such permission. I agree to hold harmless the Funhouse, its employees, volunteers, or anyone connected with the Funhouse organization for any injury or other problems arising from participation in this program. *I AgreeBy signing this form, I understand and agree that photographs/videos taken of my child(red) at The Funhouse Commons may be used by The Funhouse Commons for promoting our programs, classes, events, in print, TV, social media or on the website. *I AgreeI Do Not AgreeSignature *Clear SignatureSubmit
