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After School Program, Discovery Club 2012-2013

After School Program, Discovery Club 2012-2013

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Published by Mosholu Montefiore

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Published by: Mosholu Montefiore on Jul 30, 2012
Copyright:Attribution Non-commercial

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07/30/2012

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Child’s NameAddressApt. #AgeDate of BirthZipHome Phone #Mother’s NameFather’s NameOccupation Work #OccupationWork #Emergency Name & Telephone #Starting Date
Please check the following:
 
I understand that I am registering my child for the school year and will losemy deposit if I withdraw for any reason other than losing my employmentor moving from the area.
Parent’s signature
OFFICE USE ONLY Date _______________ Receipt # __________________ Membership _______________ Liability ___________________ Accident __________________ Security Deposit ___________ 
STARTING SEPTEMBER 10, 2012
An After School Day Care Programfor children of Working Parentsin Kindergarten to Sixth Grades(co-ed)
SchoolGrade/Class
Tues.Mon. Wed. Thurs. Fri.Early Wednesday/First Friday 6:00 - 6:30 p.m. coverage
Father’s CellMother’s Cell
2012-2013 Registration Form
2012 - 2013School Year
 
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 t  
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