Light of the Village After School Program Registration Form

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Each child attending needs a separate form.

Only the parent/legal guardian of the child may register him/her.

Registration IS NOT COMPLETE until you, the parent/legal guardian, come in person to sign your child's liability form.

Completion of this form does NOT GUARANTEE a spot at After School Program, but it DOES hold your place in line.

A director will contact you to let you know if your child has been admitted or placed on the waiting list based on the capacity of children we can safely accommodate.

Child's Name (First and Last) *

Child's Nickname (if applicable)

Child's Age *

Child's Birthday *

YYYY

Child's Gender

Female

Male

Clear selection

Child's Grade in August 2023 *

School Your Child Will Attend This Year: *

Parent or Guardian's Name *

Parent or Guardian's Phone Number(s) *

Child's Address - Street Number and Name *

Child's Address - City *

Child's Address - State *

Child's Address - Zip Code *

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