VISION After School Registration
VISION Online Registration for After School Programming at Henry R. Clissold School
Student's Name *
Your answer
Student's Grade for the 2018-2019 School Year *
Student's Birthday
MM
/
DD
/
YYYY
Parent/Guadian's Name *
Your answer
Parent/ Guadian's Email *
Your answer
Parent/Guadian's Address *
Your answer
Parent/ Guadian's Phone number
Your answer
Parent/Guardian's Occupation *
Your answer
Primary Emergency Contact's Name, Phone Number, & Relationship to Student *
Your answer
Secondary Emergency Contact's Name, Phone Number, & Relationship to Student *
Your answer
Please enter your payment confirmation number (You can find the confirmation number on your emailed receipt. If you have not submitted payment, please do that in a separate tab now because without this portion, your application will be incomplete and your child will not be registered for programming.) *
Your answer
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