2026-2027 THE CITY OF MONTCLAIR AFTER SCHOOL PROGRAM REGISTRATION FORM

2026-2027 School Year

PARENT HANDBOOK ACKNOWLEDGEMENT

Please review the MAP Parent Handbook available here: www.cityofmontclair.org/map-enrollment-information/

Note: This MAP Parent Handbook is presented for informational purposes only and can be changed at any time with or without notice. The guidelines outlined in this handbook are meant to provide parents with additional information about the Expanded Learning Program but is not an exhaustive list of expectations, policies or procedures for enrollment in MAP. Please contact the MAP Supervising Staff if you have questions about any item listed or not listed in this handbook.

I have read and understand the policies and procedures of MAP as set forth in the MAP Parent Handbook. I also understand that the MAP Parent Handbook is to be used as a guide and is meant to be a useful reference tool for MAP Policies and Procedures. I further understand that violations of these policies and procedures may result in the child being dropped from the program.

I have reviewed the MAP Parent Handbook in its entirety and I will attend the Parent Orientation where I will be given the opportunity to ask questions with the Site Lead.

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* 1. Parent/Guardian Signature (Please type first and last name)

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* 2. Please enter today's date

Today's date

Date

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* 3. School (Select only one)

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* 4. Student First Name

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* 5. Student Last Name

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* 6. Grade:

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* 7. Age:

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* 8. Date of Birth:

Please enter birthdate below

Date

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* 9. School ID#:

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* 10. Teacher:

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* 11. Gender:

Male

Female

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* 12. Home Address:

Address

City/Town

State/Province

ZIP/Postal Code

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* 13. Ethnicity:

Not Hispanic/Latino

Hispanic/Latino

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* 14. Race (please select only one):

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* 15. Please enter the name (first and last) of the student's parent/legal guardian:

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* 16. What is the above person's relationship to the student?

Father

Mother

Step-Father

Step-Mother

Grandfather

Grandmother

Aunt

Uncle

Other (please specify)

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* 17. What is the above person's home address, email, and cell/home phone number?

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Cell/Home Phone Number

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* 18. What is the above person's work phone number?

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* 19. If applicable, please enter the name (first and last) of the student's second parent/legal guardian:

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* 20. What is the above person's relationship to the student?

Father

Mother

Step-Father

Step-Mother

Grandfather

Grandmother

Aunt

Uncle

Other (please specify)

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* 21. What is the above person's home address, email, and cell/home phone number?

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Cell/Home Phone Number

2026-2027 THE CITY OF MONTCLAIR AFTER SCHOOL PROGRAM REGISTRATION FORM

2026-2027 School Year

Question Title

* 1. Parent/Guardian Signature (Please type first and last name)

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* 2. Please enter today's date

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* 3. School (Select only one)

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* 4. Student First Name

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* 5. Student Last Name

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* 6. Grade:

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* 7. Age:

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* 8. Date of Birth:

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* 9. School ID#:

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* 10. Teacher:

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* 11. Gender:

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* 12. Home Address:

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* 13. Ethnicity:

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* 14. Race (please select only one):

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* 15. Please enter the name (first and last) of the student's parent/legal guardian:

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* 16. What is the above person's relationship to the student?

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* 17. What is the above person's home address, email, and cell/home phone number?

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* 18. What is the above person's work phone number?

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* 19. If applicable, please enter the name (first and last) of the student's second parent/legal guardian:

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* 20. What is the above person's relationship to the student?

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* 21. What is the above person's home address, email, and cell/home phone number?

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* 22. What is the above person's work phone number?