Before and After Care Survey 2018-2019
School Name:
Parent/Guardian Name:
E-Mail Address
Phone Number:
Please select which box applies:
Child's Name Grade in September
(K - Grad 6)
Child 1
Child 2
Child 3
Child 4

Please indicate with a check (√) in the boxes below the days of the week that Before/After School services are required.
Before School (7:00am to bell time)
After School (Dismissal to 6:00pm)
Indicate with a (√) the activities your child(ren) like to participate in during a before and after-school program.
Do you give permission for your contact information to be shared with the not-for-profit before and after-school program provider in your school? Please indicate with a check (√) in the appropriate box.
If you would like more information about school-based before and after-school programs within the Hamilton-Wentworth District School Board, please contact Maria Agro, Manager of Parent Engagement and Early Years Leadership at 905-525-2930 ext. 2846 or