After School Program Online Registration

After School Online Registration Form

Child's Name *

First

Last

Grade *

Child's Name *

First

Last

Grade *

Mother's Name *

First

Last

Work Phone Number *

Cell Phone Number *

Father's Name *

First

Last

Work Phone Number *

Cell Phone Number *

List those who have your permission to pick up the child/children. We will use these phone numbers for emergencies also.

Name *

First

Last

Relationship *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Work Phone Number *

Cell Phone Number *

Name *

First

Last

Relationship *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Work Phone Number *

Cell Phone Number *

Weekly Pick Up Time *

One Need Pick Up Time *

My child/children will be dropped off at the St. Francis After School Program by *

Bus Car Walker Early Childhood Center

Allergies *

$5.00 per hour per child

$10.00 per hour per family

$10.00 application fee due upon registration. Send in your $10.00 fee on completing this online application to the Early Child Hood Center, 70 Adam Street, Tonawanda, NY 14150

***Please Note*** A late fee charge of $5.00 for every 15 minutes past 5:30 in cash due at time of pickup.

For more information, call the school at 692-7886, or email babcock@stfrancistonawanda.org

Submit

After School Online Registration Form

Consider a recurring Gift