Open Hearth After School Kids at WES: (Pre-K) Registration Form 2021-22

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Please complete this form to indicate your interest in having your child participate in the preschool after school program. This program is available to children 3 and up and will run 12:30 - 2:30 (or 5:30) T/Th/F and 2:30 - 5:30 M/W.

Completing this form does NOT automatically enroll you in the program. You will receive a confirmation letting you know when your child has been enrolled in our program. Families will be served on a first come, first served basis for sign ups. We can accommodate a maximum of 13 students on any day.

Child's Full Name *

Grade *

Child's date of Birth *

YYYY

Address *

Please list others living in the home - names and ages of siblings, etc.

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