Study Hall Form | villagechurch

Village Study Hall Registration

Please list all names of individuals authorized to pick up student (Pick up person, if other than parent, needs to present ID when picking up student):

I understand that for licensed drivers leaving before 3pm, parent must give prior approval.

Please note that breakfast and lunch will be provided through Clay County schools. Village staff/voluntters will pick up from Clay County schools and provide on site at Village Study Hall.

Allergies

*Relevant Medical Needs

Student Signature (Sign with mouse or finger)

Parent/ Guardian Signature (Sign with mouse finger)

*While Village staff and contractors will not administer medications, we understand students might have medical needs such as an inhaler, etc. It is helpful to know of these needs in advance.

Thanks for submitting!