Anchors Up Application

Fish Out Of Water Career Development Center, Inc.

Anchors Up After-School Program
Monday – Thursday
www.fo2w.org

PARTICIPANT APPLICATION

Middle School or High School Participants Only, Grades 7th-12th

STUDENT INFORMATION

TO BE COMPLETED BY PARENT/GUARDIAN
CHILD RELEASE CONTACTS: If I am not able to pick up my child following the Anchors Up After-School Program, I give permission for my child to be released from the program and/or to be received at the end of the program day by the following people. I understand that my child will not be released to anyone unless listed below.
MEDICAL HISTORY: Please provide facts concerning your child’s medical history including allergies, medications, and any physical impairments, for which a physician may need to be alerted.

COMMUNITY RESOURCES

PHOTO RELEASE (Please select ONE option below):

PARENT CONSENT/PERMISSION:

NOTE: STUDENTS MUST SUBMIT THEIR MOST RECENT REPORT CARD TO ATTEND