After School Program Survey

Please help us determine how to best serve you and your family with our After School and After Virtual School programming.

After School Preference Survey

Parent First Name *

First

Parent Last Name *

Last

Parent Email *

Child #1 *

Child #1 Current Grade *

Child #2

Child #2 Current Grade

Additional Children and Grades

We are interested in a program at 4-H Acres (after school hours) on

Thursday Afternoons

Friday Afternoons

We are Flexible

We are interested in a program at our child's school or an alternate location. Please list the school or tell us about your alternate location idea.

We are interested in a weekend program on

Any other requests or concerns you'd like to share?

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