2018-19 FAST ASPire After-School Programs Extended Care & Enrichment Clubs Student Registration
This contract along with a non-refundable annual registration fee is required upon enrollment in FAST ASPire Extended Care and/or Enrichment Clubs
STUDENT INFORMATION:
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student's Gender *
Student's Birth Date *
MM
/
DD
/
YYYY
Student's Grade: *
Start Date (Extended Care or Enrichment Club, whichever begins first) *
MM
/
DD
/
YYYY
Days Attending Extended Care *
Required
Days Attending Enrichment Club(s) *
Required
Name of Enrichment Club(s) Your Child Attends (if none, please type "None") *
Your answer
Allergies (if none, please type "None") *
Your answer
Current Prescribed Medications (if none, please type "None") *
Your answer
Special Needs & Conditions (if none, please type "None") *
Your answer
Child's Doctor or Clinic Name *
Your answer
Doctor/Clinic Phone Number *
Your answer
Doctor/Clinic Address *
Your answer
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