Address of your School *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of the person completing this form *

First Name

Last Name

Time of the after school club *

Hour

Minute

Second

AM PM

DAY OF THE WEEK YOU WOULD LIKE THE AFTER SCHOOL CLUB *

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

MULTIPLE DAYS