After School Registration Form

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