After School Registration

Start Date: *

Child Name: *

Child Age: *

Child's DOB:

School:

Mother/Guardian Name: *

Mother/Guardian Email: *

Mother/Guardian Phone Number: *

Father/Guardian Name:

Father/Guardian Email:

Father/Guardian Phone Number:

After School Plan: (Select One) *
After School Plus ($110 /week)After School Basic ($106 /week)Before School Care ($85 /week)Before & After School Care ($165 /week)School Days Off ($42 /day)Half Day Care ($35 /day)Early Release Program ($40 /day)*

Comments: