QUEST After School Enrichment Program, 2025

Child's Name *

First Name

Last Name

Child's Birth Date *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian #2, if applicable

First Name

Last Name

Mobile Phone #1 *

(###)

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Mobile Phone #2

(###)

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Home Phone

(###)

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Work Phone

(###)

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Emergency Contact #1 *

First Name

Last Name

Phone for Emergency Contact #1 *

(###)

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Emergency Contact #2

First Name

Last Name

Phone for Emergency Contact #2

(###)

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Doctor *

First Name

Last Name

Doctor's Phone *

(###)

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May we use your child's anonymous image for communications and social media? *

Yes

No

May we walk your child across the parking to Quest? *

Most program participants attend the Hilltop Elementary School next door, allowing them all to walk over as a group with a Quest leader.

Yes

No

Who is allowed to pick up your child at the end of their day with us? *

First Name

Last Name

Second person allowed to pick up your child.

First Name

Last Name