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BLAINE TUITION BASED AFTER SCHOOL (TBAS) REGISTRATION FORM
PLEASE SUBMIT REGISTRATION FOR EACH CHILD SEPARATELY...
2019 WINTER QTR 3 ( February 4th - April 1st)
Email address *
TBAS Enrollment Options and Payment
Please indicate if this is the first or second child that you are registering. Sibling discount rate is 25% off the original rate. *
Email address *
Your answer
Parent/Guardian First and Last Name *
Your answer
Parent/Guardian Phone Number *
Format XXX-XXX-XXXX
Your answer
Child Last Name *
Your answer
Child First Name *
Your answer
Grade Level (2018-2019) *
Please tell us the grade level your child is going into...
Your answer
Medical/Allergies *
List any Allergies or Medical concerns below, if none write: NONE
Your answer
FULL TIME (3 to 6) *
If payment is more that $500 you can pay in 2 payments the first on or by February 8th and the second on or by March 8th. If this is an additional child there is a 25% discount. Choose one option below
*
Check all that apply.
Required
HALF TIME (3 to 4:15) *
Choose One
*
Check all that apply.
Required
Additional Persons - Permission to Pick Up *
Please include second Parent/Guardian and any additional names and phone numbers of who has permission to pick up your child below. If none, write NONE.
Your answer
Questions/Concerns
Write any information, questions, concerns you may have for your child or children in regards to the After School Program.
Your answer
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