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After School Child Care Registration 2020-21
Contact Information
Parent Name
First Name
Last Name
Parent Phone
*
Email
*
Verify Email
*
Child's Name
*
First Name
Last Name
2nd Child's Name
First Name
Last Name
Select Your Child's Homeroom
*
select one
PK3
PK4
K
1
2
3
4
5
6
7
8
Select Your Child's Homeroom
select one
PK3
PK4
K
1
2
3
4
5
6
7
8
3rd Child's Name
First Name
Last Name
4th Child's Name
First Name
Last Name
Select Your Child's Homeroom
select one
PK3
PK4
K
1
2
3
4
5
6
7
8
Select Your Child's Homeroom
select one
PK3 - Fata
PK4 - Welge
PK4 - Intrieri
Kindergarten - Davis
Kindergarten - Lombardi
1 - Haight
1 - Hansen
2 - Cook
2 - Krzemienski
3 - Meese
3 - Thomas
4 - Greenfield
4 - Grall
5 - Bloom
5 - Davidson
6 - Greco
6 - Napoli
6 - Novia
7 - Carretta
7 - Lutz
7 - Novia
8 - Koproski
8 - Ohls
Days Expected to Use After Care
*
Monday
Tuesday
Wednesday
Thursday
Friday
Allergies
*
Emergency Contact Information (Name, Relationship to Child, Email, and Phone)
*
Would you like your child(ren) to complete homework in After Care?
*
Yes
No
Payment Agreement
*
Please choose a payment option below
I prefer to pay by credit card each month. Please have the Business Office contact me for my payment information.
I prefer to pay by check. Please have the Business Office invoice me monthly.
