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PreK-Kinder Afterschool Registration Form 2021-2022
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* Indicates required question
Clubhouse Participant Name
*
Your answer
Participants Age
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Your answer
Participant Program
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Preschool Kindergarten- ages 3-6 Full Day Monthly Cost : $700
Preschool Kinder + Afterschool- ages 3-6 Monthly Cost $800
After School ONLY Ages: 3-12 Cost $300
Required
Parents/Guardians Names 1
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Your answer
Email 1
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Your answer
Phone Number 1
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Your answer
Parents/Guardians Names 2
Your answer
Email 2
Your answer
Phone Number 2
Your answer
Address
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Your answer
Emergency Contact 1 (name, relation and phone number)
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Your answer
Emergency Contact 2 (name, relation and phone number)
*
Your answer
Person authorized to pick up/drop off your child (name and phone number)
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Your answer
Does your child have allergies? Please include instructions for handling the allergies!
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Your answer
Is there anything else you would like us to know about your child? Special needs or interests?
Your answer
See Website for Covid 19 Updates
*
Yes, I read these and I understand & agree to the Clubhouse guidelines!
I will read and let you know if I have any questions!
I have questions and will contact you personally!
Required
By signing this registration form you are agreeing to the "Play Adventures Clubhouse Registration Guidelines". (Please Sign and Date)
*
Your answer
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