Miller Afterschool Program Student Registration
Student Name: _____________________________________________
Best phone number to reach you: _____________________
Emergency Contact: _______________________________
Any allergies/important medical information:____________
Please list all the ways your student is allowed to transport home:
¨ ______ My student may walk/bike home.
¨ ______ My student will be riding the bus home each day.
¨ ______ Someone will pick up my student each day.
Please list each person who is allowed to transport your student home.
Name: __________________________Phone #: ______________________
Students will be picked up behind the school.
Students picked up early from the program must be signed out or have prior permission from parents to do so.
I have read and agree with the information in this contract:
Student Signature: _______________________________________________
Parent/Guardian Signature: _______________________________________Hoquiam/ Aberdeen Transportation3030 Bay Ave.Hoquiam, WA 98550Phone: 360-538-8270Fax: 360-538-8272