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Orangewood After School Program

After School Program

Orangewood After School Program Application Form
You must complete a new application for each student.

Parent/Guardian Information

Student Information

Student's Grade? *
Answer Required
Sibling #1 Grade?
Answer Required
Sibling #2 Grade?
Answer Required
Sibling #3 Grade?
Answer Required
Answer Required
If your student is a walker, you must give the After School staff permission to sign them out each day in order for them to walk home. By clicking below you authorize the After School Program staff to sign our your walker each day.
Answer Required
Has your student had any operations, serious medical conditions, or chronic illnesses? *
Answer Required
Does your child have any activity restrictions desired by the child, parent/guardian, or physician?
Answer Required
Do you have medical insurance?*
Answer Required
I grant permission for my child to participate and appear in still photography or audio-visual programming whether via television, film, audio tape, or electronic media for the Edison School District in connection with publicity, advertising, or promotion of the ASES program. I waive the right to control, approve, use, or reuse of such photograph or audio-visual programming. On behalf of myself, and my child, I also waive any right to fees, royalties, or other compensation which may arise from my child’s participation in the still photography or audio-visual programming under the log of the United States or any state thereof, or under the laws of any nation or jurisdiction. My consent of my child is valid for the current school year unless I notify the district in writing that my consent has been withdrawn. Do you consent to the above statement?*
Answer Required
I have read, understand, and agree to the conditions of my child’s participation in the ASES Program. I also verify that all the above information on my child is complete and accurate. I understand that reasonable measures will be taken to safeguard the health and safety of all participants. I will be notified as soon as possible in case of an emergency. In the event that I cannot be reached in an emergency, I hereby authorize transportation to a medical facility and/or the calling of a physician at my expense to provide whatever emergency medical treatment necessary. By clicking yes below, I give permission for my child to participate in the ASES Program.*
Answer Required
Signature Required

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