Extended Learning Program Application 2021-2022
Please complete one form for each child enrolling in the Extended Learning Program.
The Site Coordinator will contact each parent to confirm enrollment in the program.
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Please check the appropriate boxes
 Child's Name (First, Last) *
Birthdate *
MM
/
DD
/
YYYY
Age *
Child's address *
City *
Zip *
School Attending *
Child's grade *
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