AnchorUP After School Program Registration 2025-26

AnchorUP After School Program

Idaho Beyond the Bell Grant Funding

2026-2027 Student Registration

Tuesday & Wednesday 3:30 - 5:30 p.m.
Student #1 Name
Grade
Student #2 Name
Grade
Student #3 Name
Grade
Student #4 Name
Grade
Parent/Guardian Name
Best way to contact you:
Cell Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name
Best way to contact:
Email
example@example.com
Cell Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
2nd Parent/Guardian Address or enter "same address as above"

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I understand by initialing below that there is no transportation provided.
Initial
Health Concerns and/or Allergies List Here:
Emergency Contact #1:
Does Emergency Contact #1 have permission to pick up your child:
Relationship
Phone #
Format: (000) 000-0000.
Emergency Contact #2:
Does Emergency Contact #2 have permission to pick up your child:
Relationship
Phone #
Format: (000) 000-0000.
Tentative Schedule:

3:30-3:45 Snack in Cafeteria, students will walk over to cafeteria for snack

3:45-4:00 Break (devices are allowed at this time)

4:00-5:00 Tutoring in Content Areas

5:00-5:30 Anchor Up Time (activities/workshops/guest speakers/presentations)
I give consent for my student to attend the Anchor Up After School Program and participate in its activities. I understand and accept that volunteers, including other parents, mentors and members of the community will assist in the program.
I have read the attached, and my signature below demonstrates a commitment, and that I provide consent for my student to participate in the Anchor Up After School Program under the terms described above.
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

AnchorUP After School Program

Idaho Beyond the Bell Grant Funding

2026-2027 Student Registration

Tuesday & Wednesday 3:30 - 5:30 p.m.