Riverside Local Schools is surveying parents to determine whether there will be a need for afternoon (PM) Latchkey at LaMuth Middle School for the 2013-2014 school year. The Latchkey program is self-supporting, which means that program fees are used to cover all costs for staff, supplies, snacks, equipment, and games. It is with these expenses in mind that program fees are set and Latchkey sites are made available based on need. If you are interested in the PM latchkey program at LaMuth for the 2013-2014 school year, please complete the following survey.

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* 1. Which of the following days of the week would you require latchkey services? Check ALL that apply:

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* 2. Approximately what time would you be picking up your child from afternoon LatchKey?

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* 3. Parent Name:

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* 4. Name of student(s) who will attend latchkey:

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* 5. Preferred phone number where you can be reached:

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