SEASONS OF LEARNING AFTERCARE PROGRAM ONLINE APPLICATION

Roberta C. Hardy, Executive Director


Please Select the School you are interested in: *
CHILD'S INFORMATION
Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Child's Address *
Child's Address
MOTHER'S INFORMATION
Name
Name
Employers Address
Employers Address
Phone Number
Phone Number
Cell Phone Number
Cell Phone Number
FATHER'S INFORMATION
Name
Name
Employers Address
Employers Address
Phone Number
Phone Number
Cell Phone Number
Cell Phone Number
EMERGENCY CONTACTS / PICK UP LIST
Name *
Name
Address *
Address
Phone *
Phone
Name
Name
Address
Address
Phone
Phone
TERMS OF ACCEPTANCE and SIGNATURE
Upon signing this document I indicate my child is in good health and condition to attend aftercare program. I further give Seasons of Learning, Christian Pentecostal Day Care and/or its staff, permission to have my child medically treated in case of any medical emergency while in attendance and/or on a trip.
Name *
Name
I, the [applicant, requestor, etc.] for this [type of form], warrant the truthfulness of the information provided in this application.
Please type your First and Last Name
*