AFTER SCHOOL INTEREST LIST
If you are interested in After School for your child now or in the future, please complete the following form and email it back to us to be placed on our Interest List. You are also welcome to visit any one of our locations and complete the form on site, if you prefer.
FAMILY INFORMATION
Name:
*
Prefix
First
*
Last
*
Suffix
Relationship to child/children
Mother
Father
Guardian
Third option
Address:
*
Street Address
*
Address Line 2
City
*
State / Province / Region
*
Postal / Zip Code
*
Country
*
Home Phone Number:
###
-
###
-
####
Cell Phone
###
-
###
-
####
Email:
*
Confirm
*
First Child's Name:
*
Prefix
First
*
Last
*
Suffix
Female
Male
Child's Date of Birth:
*
MM
/
DD
/
YYYY
Second Child's Name:
Prefix
First
Last
Suffix
Female
Male
Child's Date of Birth:
MM
/
DD
/
YYYY
Third Child's Name:
Prefix
First
Last
Suffix
Female
Male
Child's Date of Birth:
MM
/
DD
/
YYYY
Neighborhood School:
*
School of Choice:
*
Today's Date:
*
MM
/
DD
/
YYYY
Aspects of After School:
Check all that apply
1ST-5TH GRADE
TK PROGRAM
KINDERGARTEN AM ONLY
KINDERGARTEN PM ONLY
KINDERGARTEN AM & PM
BREAKFAST CLUB
HOLIDAY PROGRAMS
KAMPARAMA SUMMER CAMP
Indicate School Year Interested In:
*
2016-2017
2017-2018
Date Time
MM
/
DD
/
YYYY
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