October 2019 Request Form

Please select the dates (minimum 4) that you require after school care as well as the other fields.
For multiple participants from the same family, we ask that you complete this form again.

NEW: Select All School Days
September 30 - October 4, 2019
October 7-11, 2019
October 15-18, 2019
October 21-25, 2019
October 28-31, 2019
Participant Information
Does the Participant Require EA Support at School?
Parent / Guardian Information
Other Information
Select a School