Child's Name

First Name

Last Name

Phone *

(###)

###

####

Please select one: *

Dismissal Time : Tuesday , Wednesday & Thursday 07:00 PM if signed up for Dance or Drums also ; Monday and Friday by 05:45 PM

Van Pick Up, Homework Help, & Activity Class - $450/month

Walking Pick Up, Homework Help, & Activity Class - $400/month

Van Pick Up & Homework Help only - $350/month

Walking Pick Up & Homework Help only - $300/month

Homework Help & Activity Class - $300/month

3-Day a Week Dance Only - $200/month( Tuesday , Wednesday & Thursday )

3-Day a Week Drum Only - $200/month( Tuesday , Wednesday & Thursday )

Homework Help Only - $200/month

Please select Activity Class *

Drums

Dance

Horns ( Free programming on Mondays , Fridays )

Do you have a voucher? (All Child Care Vouchers Are allowed) *

I would like to use my ACS Voucher

I would like to use my HRA Voucher

I don't have any voucher

If you choose pick up from school, please tell us the following We pickup from the following schools:

PS 11

PS 21

PS 93

PS 156

PS 243

PS 316

PS 392

EMPOWER

KIPP

EXCELLENCE BOYS

EXCELLENCE GIRLS

PHILIPPA SCHUYLER

LEADERSHIP PREP BED STUY

SUCCESS ACADEMY PROSPECTS HEIGHTS

SUCCESS ACADEMY BED STUY 1&2

ACHIEVEMENT FIRST ENDEAVOR

Is there a Half-Day? *

Yes

No

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (347) 264-4069 for assistance. You can reply STOP to unsubscribe at any time.

Yes

No