Re-enrollment form 2020-2021

Student's Name*
Program*
Chose one
Extra Hours
- Early Bird (7:30 -8:15 am)
- Aftercare (3:30-5:30 pm)
Guardian/Parent 1 Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Guardian/Parent 2 Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Half Enrollment Fee*
Fee payment options
- ACH my account
- Send me an invoice
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Guardian/Parent 1 Information