AfterSchool 2017 / 2018 Registration
Child #1 Full Name
Your answer
Child #1 Birthday
mm/dd/yyyy
Your answer
Child #2 Full name
Your answer
Child #2 Birthday
mm/dd/yyyy
Your answer
Parent 1 Full Name
Your answer
Parent 2 Full Name
Your answer
Family Home Address
Please record the complete home address.
Your answer
Parent(s) Telephone Numbers
Please include all work, home, and cell numbers and label accordingly
Your answer
Parent(s) Email Addresses
Please include all relevant email addresses and label accordingly
Your answer
I am interested in the AfterSchool program for Child #1, on the following days of the week:
Check all that apply
I am interested in the AfterSchool program for Child #2, on the following days of the week:
Check all that apply
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