After-School Program Enrollment Form

Dear Parents and Applicant:

Thank you for your interest in the After-School Program at UAP. Please fill out this application form completely. The hours of after-school program are from 3:45pm - 4:45pm. Any student who has received disciplinary actions or suspended may not be able to attend the after-school program.

* Indicates required field

Student Name *

First

Last

Grade *

Parent / Guardian Name *

Parent / Guardian Phone Number *

Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

I understand that my child must be picked-up by 4:45pm or an additional fee may be applied *

Agree Disagree

I understand that my child must display positive behavior during and after school or this privilege may be revoked. *

Agree Disagree

Signature of Parent / Guardian *

Today's Date *

Submit

Email: info@uapschool.org
Phone: 412-241-2124
Fax: 412-241-2123

Universal Academy of Pittsburgh
2103 Hampton Street
Pittsburgh PA 15218