Fill in the form below to sign up. (incomplete forms will not be processed)
School:
*
Teacher:
*
Child's Name:
*
Grade:
*
Parent's Name:
*
Parent's Email:
Address 1:
*
Address 2:
Postal Code:
*
Home Phone #:
*
Work Phone #:
Emergency Phone #:
*
My child will be picked up after class:
Yes
No
By:
My child will attend after-school daycare/latchkey program at the school:
Yes
No
My child will walk home:
Yes
No
Health/Other concerns:
*
I, the parent have read and understood the information listen above
*
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