CTP Before & After School REGISTRATION FORM

CTP BEFORE & AFTER SCHOOL REGISTRATION FORM

PH: 985-606-0815 •. FAX: 985-606-0186 • CELL: 985-634-3577
STUDENT INFORMATION:
NAME:First Name.    Last Name

GENDER:MALE   FEMALE

DATE OF BIRTH:Date

T-SHIRT SIZE:(SPECIFY YOUT OR ADULT)

PARENT/GUARDIAN'S NAME: First Name   Last Name

PHONE:Phone Number

EMAIL: Email

PHYSICAL ADDRESS:
Street Address    Address Line 2

City   State   Zip

If Mailing address is different from physical Address, List it below:
Street Address    Address Line 2
City   State   Zip
Does Student have any Special Needs or Allergies:
***Non-Refundable $50.00 registration fee is required to reserve a slot. CCAP is accepted, but not required. Please present this form with payment.
Should be Empty:

CTP BEFORE & AFTER SCHOOL REGISTRATION FORM