After School Registration Form 23/24

AFTER SCHOOL CARE AT MCCPS
Complete the registration form and return it to Matt Taranto or the school office.
Student Name*
Grade*
*When providing a phone number for parents, please indicate the best number to contact you during the hours of school
Parent/Guardian Name*
Phone*
Format: (000) 000-0000.
Parent/Guardian Name
Phone
Format: (000) 000-0000.
Email Address (to receive invoices)*
example@example.com
Type the Days your child will attend regularly. Write the anticipated pickup time. (example: Monday, 4:30, Thursday, 5:00, Friday, 2:45)*
A minimum of TWO emergency contacts is required.
Emergency Contact Name and Relationship to Child*
Phone*
Format: (000) 000-0000.
Phone
Format: (000) 000-0000.
Emergency Contact Name and Relationship to Child*
Phone*
Format: (000) 000-0000.
Phone
Format: (000) 000-0000.
Please note here any other information we may need to help care properly for your child, including food allergies and dietary restrictions.
Should be Empty: