Before and Aftercare Program
Child's Name *
Your answer
Sex *
Age *
Your answer
Grade *
Your answer
Parent/Guardian's Name *
Your answer
Mother's Address *
Your answer
Father's Address *
Your answer
List phone numbers where parent(s) can be reached after 2:35pm daily (Home Phone, Cell Phone, Work Phone) *
Your answer
Days Attending *
Required
List the names of two adults that you designate to pick-up your child *
Your answer
I understand payment will be billed through Smart Tuition. Your digital signature below will serve as the authorization of this document in its entirety. *
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