ASP Application
Dear Parent/Guardian,

Please fill out these forms completely. If a question does not apply to your child, write N/A (not applicable). The forms must be in the educator’s possession on or before the first day your child begins care. Please notify your educator if any of the information changes.

*Each child who is enrolling in the ASP must have a separate application.

The registration fee is $25 per family and can be paid in the school with cash, check, or money order payable to St. Patrick After School Program.
Email address *
Student Name *
First and last name
Your answer
Nickname
Your answer
Primary Language of Child *
Your answer
Primary Language of Parents *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Current Grade *
Gender *
Student's Permanent Address
Street Address *
Your answer
Apt #
Your answer
City *
Your answer
Zip Code *
Your answer
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