CHARLOTTE YOUTH ENRICHMENT BEFORE SCHOOL PROGRAM 7:15-8:30AM
CHARLOTTE YOUTH ENRICHMENT PROGRAM (BEFORE SCHOOL) 7:30-8:45
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STUDENT LAST NAME *
STUDENT FIRST NAME *
STUDENTS DOB *
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MEDICAL ISSUES YES OR NO IF YES PLEASE EXPLAIN *
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PARENT NAME *
PARENT CONTACT INFORMATION *
PRICE FOR BEFORE SCHOOL SERVICES
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PAYMENT METHOD
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I THE UNDERSIGNED PARENT OR GUARDIAN OF THE ABOVE CHILD HEREBY GIVE MY PERMISSION FOR HIM/HER TO PARTICIPATE IN THE CHARLOTTE

YOUTH ENRICHMENT BEFORE SCHOOL PROGRAM.  I UNDERSTAND THAT ONCE I PAY A REGISTRATION FEE, THAT FEE IS NON-REFUNDABLE.  I SUBMIT THAT
ALL INFORMATION GIVEN IN THIS FORM IS TRUE AND ACCURATE.  I ALSO UNDERSTAND THAT IF I GIVE FALSE INFORMATION ON THIS FORM, MY CHILD
SHALL NOT BE PERMITTED TO PARTICIPATE IN PROGRAM. 
I, THE UNDERSIGNED PARENT I HEARBY RELEASE, INDEMNIFY AND HOLD HARMLESS THE CHARLOTTE YOUTH BEFORE SCHOOL PROGRAM, ITS SPONSORS, VOLUNTEERS AND ASSOCIATES FROM ANY CLAIMS OR LAWSUITS.                                                     

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