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PROSPECT PARK

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Child's First name*

Child's Last name*

Email*

Phone*

Birthday*

Month

Day

Year

Address*

Allergies/Health condition*

After School Program*

Mondays, 2:20pm - 5:30pm (PS321)

Mondays, 2:20pm - 5:30pm (PS282)

Mondays, 4:00pm - 5:30pm (Dance class at 748 Union St)

For school pick-up only:

School's Name

Grade/class

Teacher's Name

I agree to the terms & conditions *

( Please note, that no refunds or credits will be issued.)

Signature*

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Note:

Call

(+1)9172043632

Email

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