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After School Registration Form

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Location*
- Washington, DC
- Falls Church
Today's Date*
Child's Information
Name*
First Middle Last
Preferred name
DOB*
School*
Previous Afterschool Programs attended:*
Years / Grade(s)*
Individual Education Plan (IEP)?*
- Yes
- No
Allergies, or Health Concerns*
Chronic Physical Problems/Pertinent Developmental Information*
Comments
Let us know anything else pertinent to your application, which could included extra details, questions, or a coupon code.
Family Information
Name of Parent 1*
Address of Parent 1*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Name of Parent 2
Address of Parent 2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Sibling information
Name
Current School
Grade
Name
Current School
Grade
Choice of Program and Payment Information
Falls Church - Five Days
- Registration Fee ($50)
- One Payment Plan (Five days, $4, 050)
- Two Payment Plan (Five $2, 137.50 each/
- Ten Month installment plan (Five days, $450 each)
Falls Church - Three Days
- Registration Fee ($50)
- One Payment Plan (Three days - $2,430)
- Two Payment Plan (Three days - $1,282)
- Ten Month installment plan (Three days - $2,700)
Richmond - Five Days
- Five Days, no transportation ($350/mo)
- Five Days, including bus transportation ($425/mo)
- Three Days, no transportation ($210/mo)
- Three Days, including bus transportation ($244/mo)
- Two Days, no transporation ($140/mo)
- Two Days, including bus transportation ($170/mo)
DC - Five Days
- Registration Fee ($50)
- One Payment Plan (Five Days, $3,420)
- Ten Month Installment plan ($350/mo)

Bilingual Preschool, Classes & Camps

After School Registration Form

Child's Information

Family Information

Sibling information

Choice of Program and Payment Information

Locations

Programs

Parents' Corner

Information