After School Registration Form 2006 Fall Session

After School Registration Form 2006 Fall Session

NAME:________________________________________________________________________________________________

PARENT/GUARDIAN:____________________________________________________________________________________

ADDRESS:______________________________________________________________________________________________

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Phone:_________________________cell_____________________________________________________________________

STUDENT’S AGE:________________________________________________________________________________________

SCHOOL ATTENDING:____________________________________________________________________________________

GRADE LEVEL IN FALL:___________________________________________________________________________________

NOTES ON MEDICAL CONDITIONS WE SHOULD KNOW:_________________________________________________________

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Emergency contact:_________________________________________________________________________________

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I ENCLOSE IS 10.00 REGISTRATION and 50.00 FOR THE FIRST MONTH

Tuition is due on the First Tuesday of each month.

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Parent Date