EmailMeForm
ICC Afterschool Application Form 2017
Child's Name
*
First
Last
Child's Grade
K
1st
2nd
3rd
4th
5th
Parent/Guardian of the Child
Parent/Guardian's Name
*
First
Last
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Phone
*
###
-
###
-
####
Email
*
Which school does your child attend?
*
How did you hear about our school?
*
*
Yes, I agree
By joining or registering for ICC programs, you agree to release and hold harmless organizers from and against any claim, loss, damage, liability, expense, impairment or cause of action arising out of or related to your participation.
Total
$0.00