Aftercare Registration
2018-2019 Extended Day Program Registration
Student Last Name *
Your answer
Student First Name *
Your answer
Student Grade Level *
Parent Name(s) *
Your answer
Parent Phone Number(s) *
Your answer
Please list any additional emergency contacts
1. Name
Your answer
1. Relation
Your answer
1. Phone Number
Your answer
2. Name
Your answer
2. Relation
Your answer
2. Phone Number
Your answer
3. Name
Your answer
3. Relation
Your answer
3. Phone Number
Your answer
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