Parent's or Guardian's Name *

First Name

Last Name

Child's Name *

First Name

Last Name

Phone *

(###)

###

####

What are you registering for? *

TUE & THU (Dismiss by 7:00pm )- IF signed up for drum or dance all else - (Dismiss 5:45pm (MWF)) Basketball is for Age 8-13 only

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

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

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

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

Homework Help & Activity Class - $300/month

2-Day a Week Dance Only - $200/month

2-Day a Week Drum Only - $200/month

2-Day a Week Horn Only - $200/month

Homework Help Only - $200/month

2-Day a Week Basketball Only (M&W 5 -7 PM) - age 8-13 only -
$200/month

Please select Activity Class *

Drums

Dance

Horn

N/A

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 would like to use my job voucher for child care

I don't have any voucher

For Voucher Families: Pickup

Van Pickup (5 Days a week) - $100

Walking Pickup/No Pickup - FREE

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

We pickup from the following schools:

PS 9

PS 93

PS 156

PS 243

PS 316

PS 392

EMPOWER

KIPP

EXCELLENCE BOYS

EXCELLENCE GIRLS

PHILIPPA SCHUYLER

BROOKLYN PROSPECT

EMPOWER

LEADERSHIP PREP BED STUY

SUCCESS ACADEMY PROSPECTS HEIGHTS

SUCCESS ACADEMY BED STUY 1&2

ACHIEVEMENT FIRST ENDEAVOR

Dismissal Time

Hour

Minute

Second

AM PM

Is there a Half-Day?

Yes

No