After School Registration — Little Red Playschool

After school Registration Form*

Child Name (fill out separate form for sibling(s)

First Name

Last Name

Child Birth Date

MM

DD

YYYY

Child Allergies

School Name

Teacher

Grade

Note

Please note anything else we should know, i.e. special learning needs, pronouns, etc...

Parent/Caregiver Name

First Name

Last Name

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Email

Parent/Caregiver #2 Name

First Name

Last Name

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Email

Primary Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Authorized Pick Up People

Please add up to four authorized pick up people. All will need to show proof of vaccination (can be emailed in advance)

Emergency Contact Information

Please list up to 4 additional emergency contact people/phone numbers

Registration does not guarantee a spot. Registration will be confirmed and approved pending space availability. Do not send payment until your spot has been confirmed and approved in writing. Payment must be made upon confirmation of approved registration.