Extended Day Flat Rate Choices
Please complete form once for each child you are registering for an annual Brookstone Extended plan.
Parent First Name
Your answer
Parent Last Name
Your answer
Student Name
Your answer
Best Contact Number *
Your answer
Student Grade 2018-2019
Please select which plan you would like for the 2018-2019 School Year:
Please indicate how you would like to pay for the plan:
Pertinent notes/comments
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