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Family Room After School Enrollment Form

Family Room After School Registration Form_Enrollment Details

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Primary Adult First Name

Primary Adult Last Name

Secondary Guardian First Name

Secondary Guardian Last Name

Primary Guardian Contact Email

Secondary Guardian Contact Email

Primary Guardian Contact Phone Number

Secondary Guardian Contact Phone Number

Additional Approved Adult Pickups

Child 1 First and Last Name

Child 1 Date of Birth (for accurate age)

Child 1’s Teacher Last Name – Grade – Classroom

Child 1 After School Days

Monday

Tuesday

Wednesday

Thursday

Friday

Child 1 Health, Medical, Diet

Child 2 First and Last Name

Child 2’s Teacher Last Name – Grade – Classroom

Child 2 After School Days

Monday

Tuesday

Wednesday

Thursday

Friday

Child 2 Health, Medical, Diet

Child 3 First and Last Name

Child 3’s Teacher Last Name – Grade – Classroom

Child 3 Date of Birth (for accurate age)

Child 3 After School Days

Monday

Tuesday

Wednesday

Thursday

Friday

Child 3 Health, Medical, Diet

Planned Pick Up Time

If you have a varying pickup schedule for activities, please tell us here:

Anything else we should know to support your family?

I have read and agree to the Terms and Conditions and Privacy Policies.

I agree to Family Room Chicago LLC picking up my child(ren) from school and bringing them to their business locations for after school programming. I agree to Family Room Chicago LLC and staff coordinating pickup and care with the school for immediate / urgent needs with the school. **I agree to notify Family Room Chicago and the school if my child(ren) will be absent from after school via email at AfterSchool@FamilyRoomChicago.com.

Family Room Chicago

Neighborhood Clubs & Play Spaces

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Customer Support (support@familyroomchicago.com)
312-625-7274

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