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Child Information
Please complete the following Information regarding the child enrolling in the 2017-2018 After School Enrichment (A.S.E.) Program at Sonia Sotomayor Elementary. Please complete a separate form for each child enrolling in the program.

The Program begins September 5, 2017, and provides care from 2:45pm-3:45pm on days that school is in attendance. Cost is $80 per month for the first child and $60 per month for each additional child. Payment in full for the month is due on the 1st of each month.

Child's First Name *
Your answer
Child's Last Name *
Your answer
Grade for 2017-2018 School Year *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
Any information we need to know about your child. (Allergies/medical conditions/behaviors)
Your answer
Days Child will attend *
Required
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