After School Program Enrollment Form

The Doris Wiles Center of Hope Foundation is preparing to open our After School Program for youth in our community.

We are now accepting pre-registrations for families interested in enrolling their children once we officially open.

Limited spots will be available. Please complete one form per child.

Parent's Name

First NameLast Name

Parent's Phone Number

Area CodePhone Number

Parent's Email

Student's Name

First NameLast Name

Last 4 digits of Social Security Number

Grade in Spring (2026-2027)

The following information is required. It will remain strictly confidential.

Effective date for enrollment in the DWCOH

Please indicate the month and day that this agreement is to take effect. For example, if you will be using the After School Program from the first day of school, enter 08-15-2019.

Indicate the day(s) for mornings (10AM-2PM) that you anticipate utilizing the DWCOH Program:

Indicate the day(s) for evenings (4PM-8PM) that you anticipate utilizing the DWCOH Program:

Please note any known allergies:

Please specify each person, including the name of parents, who has permission to pick up your child from the After School Program.

Authorized Person 1:

First NameLast Name

Authorized Person 2:

First NameLast Name

Phone Number 1:

Area CodePhone Number

Authorized Person 2:

First NameLast Name

Phone Number 2:

Area CodePhone Number

Authorized Person 3:

First NameLast Name

Phone Number 3:

Area CodePhone Number

Authorized Person 4:

First NameLast Name

Phone Number 4:

Area CodePhone Number

• An enrollment form is required for all students participating in the program.

• The Doris Wiles Center of Hope Foundation provides a structured, supervised after-school environment during program hours. Parents/guardians are responsible for ensuring their child’s safe arrival and timely pick-up.

• Children may only leave the program early with prior parent/guardian permission or approved sign-out. The Center is not responsible for any child once they have been officially signed out.

• Program hours end promptly at the hours of 3:00 p.m or 8:00 p.m. Any child not picked up by 3:00 p.m or 8:00 p.m. will be considered signed out, and the Doris Wiles Center of Hope is no longer responsible for supervision after that time.

• By enrolling, parents/guardians agree to follow all program policies and procedures to ensure a safe and positive environment for all youth.

• Only individuals authorized by the parent or guardian may pick up a child from the After School Program.

Written notification is required if someone other than a parent/guardian will be picking up the child.

• All students attending the After School Program are expected to follow all program rules and guidelines. Behavioral concerns may result in parent notification and possible suspension from the program.

• Students who are sick, have a fever, or show signs of contagious illness may not attend the program.

• This program is open to students currently enrolled in the Beloit School District and TLA District, grades 4K–12.

My Products

1 Child $45.00

2 Children $75.00

3+$100.00

Payment is per household. If enrolling multiple children, please submit all forms first, then complete one payment per family. Payment is required to secure your child(ren) spot.

Total $0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

I have read and understand the Statement of Fees and Statement of Policy contained here.

Doris Wiles Center of Hope Inc, After School Pre-Enrollment Form

Statement of Policy

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Payment Methods