2023-2024 Extended Day Registration Form
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Email *
Student Last Name *
Student First Name *
Student Middle Name *
Grade For 2023-2024 *
Birth Date
MM
/
DD
/
YYYY
Street Address
City *
State *
Zip Code *
Contact Person *
Contact Number *
Legal Guardian Name(S) If different from above If not put N/A *
Legal Guardians Address( If different from above if not put N/A) *
Enrollment Information : Check all that apply *
Required
I understand that a one-time a year, non-refundable fee of $40 per family will be required once my child is removed from the waitlist. If the child transfers to another school where a program exits, the $40 fee must be paid again. Please type your name below that you understand. *
Date *
MM
/
DD
/
YYYY
Submit
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