GUSD After School Program Enrollment

Please select an option to continue(Required)

First Time Enrollment

Pay for a New Month

Student's First Name(Required)

Student's Last Name(Required)

Date of Birth(Required)

Grade in August 2022(Required)

School(Required)

Name of Teacher (if known)

Home Address(Required)

Street Address City State ZIP Code

Parent/Guardian #1 Name(Required)

Parent/Guardian #1 Phone(Required)

Parent/Guardian #1 Email(Required)

Parent/Guardian #2 Name

Parent/Guardian #2 Phone

Parent/Guardian #2 Email

Emergency Contact (other than parent)(Required)

Emergency Contact Phone(Required)

Allergies

Which days will the student be attending the after school program?(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Pickup Time(Required)

Is there any other important information we should know?

Monthly(Required)

Price:

Payment For(Required)

Billing Address(Required)

Street Address City State ZIP Code

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name