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

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

After school program transportation information: *All students need to be picked up by 5:30pm*

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.

Volunteers and Mentors

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

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