Extended After School Pick up Registration Form
Please note that this program is only available to our current students. In order to ensure that we have all of the necessary information for each individual student, please complete a separate form for each child that you are registering, $25 for a single day or $150 monthly.
Parent Name
*
First Name
Last Name
Student Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Would You like to register your child for daily or Monthly
Daily Cost $25 (pay by this registration)
Monthly Cost $150.00 Monthly (pay by this registration)
Monthly Extended After School Program
September 2023
October 2023
November 2023
December 2023
January 2024
February 2024
March 2024
April 2024
May 2024
June 2024
write Days
Note to Staff:
please let us know if you have any questions, concerns or requests.
My Products
*
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next
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Daily Fee
Pick how many days do you need?
$
Free
Quantity
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Monthly Fee
$
Free
Quantity
0
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Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
Should be Empty: