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Student Form

Please choose the option

Please choose the option
A
B

Weeks:

Weeks:

AM Care (8 AM to 9 AM)

AM Care (8 AM to 9 AM)

PM Care (4 PM to 6 PM): 

PM Care (4 PM to 6 PM): 

AM & PM Care

AM & PM Care

Lunch

Lunch

Student's Full Name

Date of Birth
Current Grade
Current School

Allergy & Medical History


Parent's Full Name
Address
Emergency Contact Info
How did you hear about us?

I, Parent/Guardian of the applicant, have read and fully understood the Enrollment Policy & Liability Waivers. By checking this box, I confirm that I will abide by all the terms

I, Parent/Guardian of the applicant, have read and fully understood the Enrollment Policy & Liability Waivers. By checking this box, I confirm that I will abide by all the terms

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