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The Bridge Extended Learning Program Application

The Bridge After School Program provides safe, engaging, and affordable childcare for students in grades K–6. Our program offers a nurturing environment where children can receive homework help, participate in fun activities, and build positive relationships.


Whatever your child needs our trained staff is committed to supporting their growth, creativity, and well-being. We partner with parents to ensure every child’s needs are met while providing peace of mind during working hours.


  • Complete all sections of this application form. Incomplete applications may delay enrollment.

  • One application per child is required.

Section 1 – Student Information

Birthday
Month
Day
Year

Section 2 – Parent/Guardian Information

Section 3 – Emergency Contacts (Other Than Parent/Guardian)

Authorized to Pick Up? (Yes/No)

Section 4 – Pick-Up Authorization

Section 5 – Program Schedule

Will your child attend: Which days will your child attend? (Check all that apply: Mon / Tue / Wed / Thu / Fri)
Approximate Drop-Off Time:
Time
HoursMinutes

Section 6 – Medical & Safety Information

Section 7 – Special Needs or Additional Support

Section 8 – Permissions & Agreements

Photo/Video Permission: Do you give permission for your child to be photographed or recorded for program use/social media? (Yes/No)
Transportation Permission: If applicable, do you give permission for your child to ride in program-approved transportation? (Yes/No)
Emergency Medical Consent: Do you authorize emergency medical care if you cannot be reached? (Yes/No)
Policy Agreement: Do you agree to follow the program’s policies and payment schedule? (Yes/No)

Section 9 – Signature

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Date
Month
Day
Year
Choose a service
Choose a service
Choose a service
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