FEE: Cash

Check

REGISTRATION FORM

$10.00 fee per family

Before and After School starts on 8/29/07, the first day of school

(Please Fill Out, Detach, and Return)

1 Sheet Per Family

I have read and understand all policies stated in the Before School / After School Program Handbook.

_____________________________

Parent/Guardian Signature

Child’s Name: ____________________________ Grade: _____________

_____________________________ Grade: _____________

_____________________________ Grade: _____________

_______ We will be using the program on a part-time basis.

_______ We will be using the program for Early Dismissal days. (12:30 p.m.)

_______ We will be using the program for late opening days. (10:30 a.m.)

_______ We will be using the program on a full-time basis as indicated below:

Please fill in the DAYS AND TIMES:

Before School hours:___________________________________________

After School hours:____________________________________________

Please indicate the date your child will start Before School and/or After School:_______________________