Before and After School Registration Form
Childs Name
*
First Name
Last Name
Parent Name
*
First Name
Last Name
Contact Number
*
Format: (000) 000-0000.
Email Address
*
Parent or Emergency Contact
*
First Name
Last Name
Contact Number
*
Format: (000) 000-0000.
Email Address
*
Please check the services you need and fill in the appropriate days of the week and times.
Before School - 7:00-8:30am
Select Days of the Week you will need AM Care:
Monday
Tuesday
Wednesday
Thursday
Friday
My Drop Off Time:
*
After School - 2:30-4:30pm
Select Days of the Week you will need PM Care:
Monday
Tuesday
Wednesday
Thursday
Friday
My Pick Up Time:
*
After School and Before School
Select Days of the Week you will need AM & PM Care:
Monday
Tuesday
Wednesday
Thursday
Friday
My Drop Off Time:
*
My Pick Up Time:
*
Signature
*
Submit
Should be Empty: