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Natural Born Champions
NBC 2021-2022 Services
Ages 3-65 welcome to participate!
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* Indicates required question
NBC Hours of Operation
Monday-Friday
7:00am - 6:00pm
Parent's Full Name
*
Your answer
Address (Street, City, Zip)
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Would you like to receive text reminders of due dates, promotions, and updates?
*
Yes
No
Participant’s Full Name & Grade/Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Are you interested in any of our current programs? (check all that apply)
*
Before Care (ages 2-12)
After Care (ages 2-12)
Before & After Care (ages 2-12)
Little Champions Care (ages 2-4)
Transportation
Virtual Learning (ages 2-12)
Summer Camp (ages 2-12)
Required
School Name/Workplace & Address (Street, City, Zip)
*
Your answer
What time does school begin for your child?
*
Time
:
AM
PM
What time does school end for your child?
*
Time
:
AM
PM
Little champions care begins at 8:00am and ends at 2:30pm. Little champions care students may attend NBC's before & after care program at a discounted price. Would you like to enroll your child in little champions care program?
*
Yes
No
Do you or your child need transportation? (Additional fee)
*
Yes
No
Where are we picking up and/or dropping your child off? This applies to all participants.
*
Home ->School
Home-> School->Home
NBC Center -->School (Before Care)
Home ->NBC Center ->School (Before Care)
NBC--> School -->NBC (Before & After Care)
Home -> NBC --> School ---> NBC --> Home (Before & After Care)
Home->NBC->School->NBC (Before & After Care)
School -> Home
I will pick-up & drop-off my child
Pick up address (home or school address)
Your answer
Drop off address (home or school location)
Your answer
Which days do you need transportation? (check all that apply)
*
Monday
Tuesday
Wednesday
Thursday
Friday
None
Required
When would you like to begin services?
*
MM
/
DD
/
YYYY
Allergies (yes or no)
*
Your answer
Medication(s) that travel with student
Your answer
Who should we contact in case of emergency? (Include full name & phone number)
*
Your answer
Is your child allowed to be posted on the NBC website?
*
Yes
No
Can we keep your info. for future purposes?
*
Yes
No
How do you plan to pay?
*
Weekly
Monthly
Referred by: (IG, Facebook, school name, friend, etc.) please write the name or tag name of your referral
Your answer
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