JaxPAL Afterschool Registration

Afterschool - 2024

Child Details

Child Details

Name

Name

First

First

Last

Last

Age

DOB

Sex

Male

Female

Shirt Sizes

Address

City

Zip

DCPS Student ID # (DCPS Students Only)

School

Current Grade

Last 4# SS

Eligibility

If Other

Ethnic Group

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Parent/Guardian Email Address

Household Income:

* Family units exceeding 8 add $7,326 each person

Number of Child

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