Event Registration
Event Timing: February 3, 2020 8AM
Event Address: ONLINE REGISTRATION ONLY
Contact us at phcccoop@gmail.com
Child's Name *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
Child's Gender *
Parent Name #1 and phone number *
Your answer
Parent #1 Occupation *
Your answer
Parent #1 Email *
Your answer
Parent Name #2 and phone number
Your answer
Parent #2 Occupation
Your answer
Parent # 2 Email
Your answer
Address (House Number, Street, City, State & Zip) *
Your answer
Class Choice *
Student Status *
Is either Parent CPR certified? If so, who? *
Your answer
Child Resides with? *
Brothers and Sisters- names and ages *
Your answer
Is the child toilet trained? (Child must be toilet trained before school begins) *
List any special concerns about your child here:
Your answer
Parent job preference, please list three from the following list in order: https://www.phcccoop.org/parent-jobs/ *
Your answer
I understand that the $125 registration fee must be received via mail @ PHCC 9534 Bel Air Rd Nottingham, MD 21236 **OR** via paypal (button on main site) no later than 3 business days after registration. If this is not paid, your child will lose their spot. *
Required
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