All School Year

Aftercare Registration

Safe, structured after-school support for children and teens with disabilities. Space is limited — secure your spot today.

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Program Dates

All School Year

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Hours

2:30 PM – 6:00 PM

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Location

The Canaan Center

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Ages Served

Teens (12–18)

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Aftercare has limited enrollment. Registrations are reviewed on a first-come, first-served basis. Submitting this form does not guarantee a spot.

Step 1

Child Information

Child’s First Name *

Child’s Last Name *

Date of Birth *

Age *

Gender

Grade / School Year *

Expected Pickup Time

Diagnosis / Disability (if applicable)

Step 2

Parent / Guardian Information

Full Name *

Relationship to Child *

Phone Number *

Email Address *

Best Way to Reach You

Home Address *

Step 3

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Relationship to Child *

Step 4

Enrollment & Funding

Does your child have Medicaid? *

YesNo

Ready to submit?

By submitting this form, I confirm that the information provided is accurate and that I am the parent or legal guardian of the child listed. I understand that submission does not guarantee enrollment and that a Canaan Center team member will contact me to confirm next steps.

I agree to the above statement and consent to The Canaan Center contacting me regarding this registration. *