CONTINUED CARE REGISTRATION

2010-2011 SCHOOL YEAR

Parents Name   ____________________________________________

Address  _________________________________________________

City ____________________________________   Zip____________

Home phone #_________________________________           ______

Mother work #________________________________             ______

Mother cell #_________________________________              ______

Father work #_________________________________             ______

Father cell # __________________________________            ______

                          (Number 1-5 in order to be called for emergency)

Name (s) and grades of child(ren) to be enrolled:

_____________________________________________           _______

_____________________________________________           _______

_____________________________________________           _______

_____________________________________________           _______

Please list below any and all people, and their phone numbers, who are authorized  to pick up your child(ren). 

_____________________________________________        __________

_____________________________________________      ­­­­­­­  ________­­­­__

­­­­­­­­­­­­­­­­­­_____________________________________________        __________

 $25.00 enrollment fee must be paid at time of registration. Check #______