After School Registration Form

Student First Name (required)

Student Last Name (required)

Home Address (required)

---K- Mrs. SetkaK- Ms. RooneyK - Mrs. Maza1 - Ms. Drescher1 - Mrs. Morales1 - Mrs. Nahm2 - Mrs. Nikas2 - Mrs. Pacana2 - Ms. Kassis3 - Mrs. Skinner3 - Ms. Palummier3 - Mrs. Warszniter4 - Mrs. Russo4 - Mrs.Dobish4 - Ms. Seaver4 - Ms. Auger4- Mrs. Wood5 - Mrs. Lerner5 - Mrs. Winters5 - Mrs. Malki5 - Mrs. Zanone5 - Mrs. Farina

---World of Wizards / Grades K - 2 / Cost: $ XXXXSolar Space Fleet Workshop / Grades 3 - 5 / Cost: $ 146Forces of Nature with LEGOs / Grades: K - 2 / Cost: $140Painting Class w/Mrs. Ramsden / Grades 3-5 / Cost: $XXXTastes Around the World / Grades 2 - 5 / Cost: $ XXXDesign the Runway / Grades K - 2 / Cost:Spanish for Beginners w/Ms. Hill / Grades 2 - 5 / Cost:Coasters & Contraptions / Grades 3 - 5 / Cost: $ 145Pokemon Go-Style / Grades K-2 / Cost:Newspaper Club / Grades 3 - 5 / Cost:Engineering for Kids / Grades 1 - 3 / Cost:Painting class w/ Ms. Gray / Grades K - 2 / Cost:

Patents / Guardian Information:

Patents/Guardian First Name (required)

Patents/Guardian Last Name (required)

Parent Email (required)

Patents / Guardian Information 2:

Patents/Guardian First Name

Patents/Guardian Last Name

Cell Number:

Parent Email

Emergency Contact - other than Patents/Guardian:

First Name

Last Name

Cell Number:

Please list the people authorized to pick up your child

My Child will go to After Care:
YesNo

Special instructions you would like us to know:

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