2. The following form is required for every participant in Roanoke County's After School for Kids programs, as well as Camp Roanoke. *Please note that this form does not guarantee admission into the ASK program. You will be contacted by ASK staff to confirm your child’s enrollment.
4. Participant Last Name*
5. Participant First Name**
6. Middle Initial*
7. Participant Gender*
   -- Select One --MaleFemale
9. Date of Birth*
10. School Attending*
11. Grade (as of August 2025)*
13. Date you would like your child to begin the ASK program:*
15. Parent/Guardian Contact Information:
17. Guardian 1 Name*
18. Telephone:*
19. Email Address*
21. Address1*
23. City*
24. State*
25. Zip*
27. Parent/Guardian Information:
29. Guardian 2 Name*
30. Telephone:*
31. Email Address*
33. Address1*
35. City*
36. State*
37. Zip*
39. If you have any questions or would like more details about the ASK program, please contact our administrative office at (540) 647-7404.
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field