Learner Support Time Sign-Up
Please complete this form for each child you would like to participate.  If you have more than one child participating, please compete a separate form for each child.   

Learner Support Time will begin on Monday October 2nd, 2023

If you have any questions, please contact Nicole Brubaker at 717-664-1807 or at brubakern@manheimcentral.org.

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First Name of Learner *
Last Name of Learner  *
Grade Level *
Parent/Guardian Name (first and last) *
Phone Number *
Email Address *
Please select the option that applies for your child: *
I understand that I will need to pick my child up at 3:55 PM at the front of the building.  *
Required
Additional Comments/Questions
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