Child & Family Information
PARENTS: Please complete one separate form for EACH CHILD in your household who will be participating in After School Care for the month of SEPTEMBER. ***Please note: the cost per child is $6/hour, rounded to the nearest :10 minutes***
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Child's Last Name:
Child's First Name:
Child's Teacher (if known):
Name of parent/guardian completing form:
Primary Contact Phone #
Please list the names of anyone who may be expected to pick up your child:
Does this child have other siblings who will be coming to our program?
Is there anything else you would like us to know about your child (Allergies, special concerns, etc.)?
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This form was created inside of St Andrews CDS.