AnchorUP After School Program Registration 2025-26

AnchorUP After School Program

Idaho Beyond the Bell Grant Funding

2025-2026 Student Registration

September 8, 2025 - May 13, 2026

Monday - 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*

TextPhone callEmail

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

TextPhone callEmail

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

Pick UpBus

Health Concerns and/or Allergies List Here:

Emergency Contact #1:*

YesNo

Relationship*

Phone #*

Format: (000) 000-0000.

Emergency Contact #2:

YesNo

Relationship

Phone #

Format: (000) 000-0000.

Yes, I am committed to volunteer. This program relies heavily on community support with volunteers and mentors. We welcome volunteers and mentors to help support our program. The program will provide a volunteer schedule. We MUST have volunteers to make our program engaging and safe.

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 Anchor Up Time (activities/workshops/guest speakers/presentations)

5:00-5:30 Tutoring in Content Areas

YesNo

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*

Date