Red Wing Before and After School Program Registration
Please read through the registration package before completing this form
Name of Child 1 being Registered for Program *
First and last name
Birthdate of Child 1 being registered for Program *
MM
/
DD
/
YYYY
Grade of Child 1 being registered for Program *
Will Child 1 Be Full-Time or Part-Time Attender? *Rates vary dependent on number of children/family in program. Check registration guide for details. *
Which Blocks would you like to register Child 1 for? *
Required
Name of Child 2 being Registered for Program If Applicable
First and last name
Birthdate of Child 2 being registered for Program If Applicable
MM
/
DD
/
YYYY
Grade of Child 2 being registered for Program If Applicable
Will Child 2 Be Full-Time or Part-Time Attender? *Rates vary dependent on number of children/family in program. Check registration guide for details.
Clear selection
Which Blocks would you like to register Child 2 for?
Name of Child 3 being Registered for Program If Applicable
First and last name
Birthdate of Child 3 being registered for Program If Applicable
MM
/
DD
/
YYYY
Grade of Child 3 being registered for Program If Applicable
Will Child 3 Be Full-Time or Part-Time Attender? *Rates vary dependent on number of children/family in program. Check registration guide for details.
Clear selection
Which Blocks would you like to register Child 3 for?
Name of Parent/Guardian 1 *
Parent/Guardian 1 Phone Number (Primary Contact #)
Parent/Guardian 1 Email Address
Name of Parent/Guardian 2
Parent/Guardian 2 Phone Number (Primary Contact #)
Parent/Guardian 2 Email Address
Emergency Contact Person 1 (Include Name and Contact Number) *
Emergency Contact Person 2 (Include Name and Contact Number) *
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