AFTERCARE REGISTRATION 2026-27

SCSS Aftercare Registration

Please use this form to register your child(ren) for the SCSS Aftercare Program.

Step 1: Complete this one-time registration form and press submit to be directed to the payment page. Pay the $40 annual registration fee.

Step 2: After your registration is complete, with payment, you will be directed to our SignUpGenius, where you will sign up for the specific days your child(ren) will attend Aftercare.

Step 3: Aftercare charges will be billed through your FACTS account based on your child's attendance.

If you have any questions about the Aftercare program, please contact our Aftercare Director, Mrs. Kiss, at LKiss@scsstrumbull.org

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Family Name
Student Name Student Name First Last
Grade

Grade Pre-K 3 Pre-K 4 Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade
Are you registering for more than 1 child?

Are you registering for more than 1 child? Yes No
2nd Student Name 2nd Student Name First Last
Student #2 Grade

Student #2 Grade Pre-K 3 Pre-K 4 Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade
Are you registering for any other children?

Are you registering for any other children? Yes No
3rd Student Name 3rd Student Name First Last
Student #3 Grade

Student #3 Grade Pre-K 3 Pre-K 4 Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade
What days will Student #1 be attending?

What days will Student #1 be attending? Monday Tuesday Wednesday Thursday Friday Occasionally
Please describe your anticipated Aftercare needs for Student #1.

For example, which days of the week, how often, or any other details that will help us plan.
What days will Student #2 be attending?

What days will Student #2 be attending? Monday Tuesday Wednesday Thursday Friday Occasionally
Please describe your anticipated Aftercare needs for Student #2.

For example, which days of the week, how often, or any other details that will help us plan.
What days will Student #3 be attending?

What days will Student #3 be attending? Monday Tuesday Wednesday Thursday Friday Occasionally
Please describe your anticipated Aftercare needs for Student #3.

For example, which days of the week, how often, or any other details that will help us plan.
Parent/Guardian Name - First to be contacted Parent/Guardian Name - First to be contacted First Last
Parent Phone - First to be contacted Parent Phone - First to be contacted - ### - ### ####
Parent Email - First to be contacted
Parent/Guardian #2 Name - Second to be contacted Parent/Guardian #2 Name - Second to be contacted First Last
Parent #2 phone - Second to be contacted Parent #2 phone - Second to be contacted - ### - ### ####
Parent 2 Email
EMERGENCY CONTACT 1 & AUTHORIZED PICK-UP PERSON #1: Please list names of FIRST Emergency Contact/ Person authorized to pick up your child from Afterschool. (Please use the name on their Driver's License so we can verify their identity and ensure the safety of all children) EMERGENCY CONTACT 1 & AUTHORIZED PICK-UP PERSON #1:

Please list names of FIRST Emergency Contact/ Person authorized to pick up your child from Afterschool. (Please use the name on their Driver's License so we can verify their identity and ensure the safety of all children) First Last
EMERGENCY CONTACT & AUTHORIZED PICK-UP PERSON #1: Phone # EMERGENCY CONTACT & AUTHORIZED PICK-UP PERSON #1: Phone # - ### - ### ####
EMERGENCY CONTACT & AUTHORIZED PICK-UP PERSON #1: Relationship to Child?
EMERGENCY CONTACT 2 & AUTHORIZED PICK-UP PERSON #2: Please list names of SECOND Emergency Contact/ Person authorized to pick up your child from Afterschool. (Please use the name on their Driver's License so we can verify their identity and ensure the safety of all children) EMERGENCY CONTACT 2 & AUTHORIZED PICK-UP PERSON #2:

Please list names of SECOND Emergency Contact/ Person authorized to pick up your child from Afterschool. (Please use the name on their Driver's License so we can verify their identity and ensure the safety of all children) First Last
EMERGENCY CONTACT & AUTHORIZED PICK-UP PERSON #2: Phone # EMERGENCY CONTACT & AUTHORIZED PICK-UP PERSON #2: Phone # - ### - ### ####
EMERGENCY CONTACT & AUTHORIZED PICK-UP PERSON #2: Relationship to Child?
Does your child have allergies or are there medical conditions that we should be aware of?

Does your child have allergies or are there medical conditions that we should be aware of? Yes - My Child has Food Allergies Yes - My Child has a Medical Condition No allergies or medical conditions
Name of child(ren) with Food Allergies:
Name of child(ren) with Medical Condition(s):
Please describe medical conditions and list all allergies or any important information our Aftercare staff should know:
Is there any other information you feel is important for the Aftercare Coordinator and staff to know about your child(ren) or the Aftercare coverage that you need?

AFTERCARE REGISTRATION 2026-27

AFTERCARE REGISTRATION 2026-27

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