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SACC Pre-Registration 2021-2022
**A non-refundable $40.00 registration fee is due at time of registration.**
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In the event that your child obtains a spot within the SACC program, a complete registration packet (a different google form), emergency card, physical (good for 2 years) & up-to-date immunization record must be completed & turned in at time of offer. This is done for every child EVERY school year. All paperwork MUST be submitted prior to their first day of attendance.
Child's name
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Your answer
Male or Female
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Female
Male
Child's Age
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Your answer
Grade Fall 2021-22
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Your answer
Care Needed
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AM only
PM only
AM & PM (Full-Time)
Drop-in
Sibling(s) attending SACC? (You must complete a separate form for each child)
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Yes
No
Name(s) of siblings attending SACC. If none, type NA.
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Your answer
Indicate any medial concerns or special needs your child requires that we need to be aware of such as medications, allergies, health conditions, behavior challenges, aides, etc.
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Your answer
Email address for paperwork to be sent when a spot in the program becomes available:
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Your answer
Parent #1: Name
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Your answer
Parent #1: Cell Phone Number
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Your answer
Parent #1: Work Phone Number
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Your answer
Parent #1: Address (full address please)
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Your answer
Parent #1: Email Address
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Your answer
Parent #2 Name
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Your answer
Parent #2 Cell Phone Number
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Your answer
Parent #2: Work Phone Number
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Your answer
Parent #2 Address (Full address please)
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Your answer
Parent #2: Email Address
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Your answer
This serves as your signature. Please type your full name.
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Your answer
Today's Date is:
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MM
/
DD
/
YYYY
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