BASC Registration
I'm registering for the school year:
One Child or Two or More Children? *
Family Name *
Parent Signature *
Address *
City *
State *
Zip Code *
Parent One - Name *
Primary Phone *
Secondary Phone *
Place of Employment *
Primary Email *
Secondary Email *
Parent Two - Name *
Primary Phone *
Secondary Phone *
Place of Employment *
Primary Email *
Secondary Email *
Pay As You Go (Billed by the hour)
Clear selection
Discounted Monthly Rate
Clear selection
Staff Child
Clear selection
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