Parent's or Guardian's Name *

First Name

Last Name

Child's Name *

First Name

Last Name

Phone *

(###)

###

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Do you have a voucher?

All Child Care Vouchers Are allowed

I have a scholarship from the school

I would like to use my ACS Voucher

I would like to use my HRA Voucher

I would like to use my job voucher for child care

I don't have any voucher

What are you registering for? *

$300/class; Free for Scholarships and Voucher. (Dismissal by 5:30 PM; Scholars are 4:30 PM)

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