Edison Club Registration Form
Registration for Edison Club Before & After School Care Program.

Please complete this online registration form and then send your $25 (non-refundable) registration fee. Information on how to pay is at the end of this form.

If you have any questions, email Edison Club at edisonclub@menloparkacademy.com or call the main office 440-925-6365.

Family Name *
This will serve as your invoice name.
Your answer
Student Information
Child's Name (1) *
Child #1 First and Last Name
Your answer
Grade *
Child #1
Child's Name (2)
Child #2 First and Last Name
Your answer
Grade
Child #2
Child's Name (3)
Child #3 First and Last Name
Your answer
Grade
Child #3
Child's Name (4)
Child #4 First and Last Name
Your answer
Grade
Child #4
Child's Name (5)
Child #5 First and Last Name
Your answer
Grade
Child #5
Parent/Guardian Information
Primary Parent/Guardian First and Last Name *
Your answer
Primary Parent/Guardian Cell Phone Number *
Your answer
Primary Parent/Guardian Email Address *
Statements/Invoices will be sent to this email address.
Your answer
Primary Parent/Guardian relationship to child(ren) *
Secondary Parent/Guardian First and Last Name *
Type N/A if there is no other parent/guardian for your family.
Your answer
Secondary Parent/Guardian Cell Phone Number *
Type N/A if there is no other parent/guardian for your family.
Your answer
Secondary Parent/Guardian Email Address *
Type N/A if there is no other parent/guardian for your family. Statements/invoices will be sent to this email address.
Your answer
Secondary Parent/Guardian relationship to child(ren) *
Schedule
Please indicate your schedule for the year. If changes need to be made, please contact the director. *
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