Extended Day Sign Up Sheet - The Imani School

1. My child will...

be picked up by 4p.m. in the front lobby be picked up by 4p.m. in the car line

2. My Child will stay for extended day or extra-curricular activities on the following day(s):

Monday Tuesday Wednesday Thursday Friday

3. Student's Name *

4. Grade *

5. Gender * (1 required)

Male Female

6. Teacher *

7. Student's Name

8. Grade

9. Gender

Male Female

10. Teacher

Parent/Guardian Contact Information

11. Name *

12. Cell Phone *

13. Home Phone

14. Work Phone

Parent/Guardian Contact Information

15. Name

16. Cell Phone

17. Home Phone

18. Work Phone

Acceptable contact for child's pick-up

19. Name

20. Phone

21. Name

22. Phone

23. Enter Your Email Address: *