July After School Program

Monthly $400 (1 class free

9 Sessions
Each Session $50 *

July 1st WednesdayJuly 6th MondayJuly 8th WednesdayJuly 13th MondayJuly 15th WednesdayJuly 20th MondayJuly 22nd WednesdayJuly 27th MondayJuly 29th Wednesday
Total

$0.00
Child name
First Name Last Name
Birth Date

Month Day Year
Grade
Current school
Parent 1 name
First Name Last Name
Parent 1 cellphone
E-mail
Parent 2 name
First Name Last Name
Parent 2 cellphone
Parent 2 email
Emergency contact name
First Name Last Name
Emergency contact Cellphone number
Allergies?

YesNo
Please detail

Payment

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Postal / Zip Code

Country

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