Open Hearth at Waitsfield Elementary School After-School Kids Registration Form 2020-21
Child's Full Name *
Child's date of Birth *
MM
/
DD
/
YYYY
Grade *
Address *
Please list others living in the home - names and ages of siblings, etc.
List two additional people who may be called in an emergency if the parents are unavailable
. Please include full name, relationship, and phone number. *
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