Learnika After School Registration Form
for school year 2021 - 2022
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Program Overview
Student Name *
Grade *
Classroom at Escondido or other school name
Parent's name *
Email Address *
Best Phone Number To Contact *
Second best phone number
Days at Learnika After-School Care                                           Please check as many as you would like.
Please send tuition payment to: Learnika 572 College Ave. Palo Alto CA 94306
Enter Electronic Signature *
Please type your name in the box below
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