Bayonne Board of Education Before/After School Child Care Program #6

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Email *

Please submit 1 form for each child you are registering for Before Care and/or After Care.

Horace Mann Community School

Use this form if you are registering for Before Care and/or After Care at Horace Mann Community School only.

Grade *

Homeroom (i.e., 201) *

Registration 2021-2022

Please submit one form for each child you are enrolling in Before Care and/or After Care.

Please check one option. *

Before Care Only

After Care Only

Before Care and After Care

Required

Student's Name *

Age *

Date of Birth *

YYYY

Home Address *

Parent #1 Name *

Parent #1 Cell Phone Number *

Parent #1 Email Address *

Parent #1 Home Phone Number (If none, state 'none') *

Parent #1 Work Phone Number (If none, state 'none') *

Name & Address Work Parent #1 (If none, state 'none') *

Parent #2 Name *

Parent #2 Cell Phone Number *

Parent #2 Email Address *

Parent #2 Home Phone Number (If none, state 'none') *

Parent #2 Work Phone Number (If none, state 'none') *

Name & Address Work Parent #2 (If none, state 'none') *

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