Parent Name

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* 1. Parent Name

School(s) your child or (children) will attend next year

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* 2. School(s) your child or (children) will attend next year

Would your child (children) attend an after school program?

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* 3. Would your child (children) attend an after school program?

How many days per week would your child attend an after school program?

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* 4. How many days per week would your child attend an after school program?

Why would you enroll your child (children) in the after school program?

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* 5. Why would you enroll your child (children) in the after school program?

What programs or support would your child (children) benefit from most?

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* 6. What programs or support would your child (children) benefit from most?

Any comments or concerns?

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* 7. Any comments or concerns?

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