| REGISTER NOW BY PHONE! |
Child's First Name:___________________________________ Last:___________________ Birthday:___________
(If enrolling 2 children...) 2nd Child's First Name:_____________________ Birthday:__________
(If enrolling 3 children...) 3rd Child's First Name:_____________________ Birthday:__________
Parent Names:________________________________________
Other brothers/sisters Names:________________________________________
Street:________________________________________ City:_______________________ State:_____ Zip:______________Home Phone:________________________________
Primary Contact’s Cell Phone(s):___________________________
Names of people who may pick up child from class:___________________________________________
Note: You must notify teachers at drop-off if someone else will be picking up your child.
How did you hear about us? (Check off all that apply.)
[ ] Walked in [ ] Drove by [ ] News
[ ] Other parent:___________________
[ ] From advertisement in:________________or
[ ] We are re-enrolling. | Camp 1: Tech Savvy Learning Center 103 South Tyson Ave Floral Park (516) 457-3285
|
|
|
|
|
|
|
|
|
Computer at Home: [ ] No [ ] Yes
E-mail:_____________________________________________________________________
Anything we should know? (Important allergies, other phone numbers, medications, special needs or conditions, favorite interests, etc.)
____________________________________________________________________________________________________
____________________________________________________________________________________________________ |
|
| Parent/Guardian Signature:_____________________________Date:__________________________ |