After School Drop Off Authorization

If you are interested in enrolling your child, please complete the following documents

Student

DOB:

Address:

Telephone:

I authorize my child to be dropped off at the following location:
Kidz with Hope Youth Organization, Inc After School Program
716 Gilbert Street, Durham, NC

Please drop my child there on the following school days: (please check)

Tuesday Wednesday Thursday

This will begin on the following date:

Signature

Parent/Guardian Telephone: