Pre-Registration Form
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1. Default Section
1
. Name
Name
2
. Address
Address
3
. Home Phone
Home Phone
4
. Work Phone
Work Phone
5
. Email Address (by providing your email address, you are giving the Carlisle Family YMCA permission to send you emails regarding school age child care services as well as YMCA membership and program information.)
Email Address (by providing your email address, you are giving the Carlisle Family YMCA permission to send you emails regarding school age child care services as well as YMCA membership and program information.)
6
. Please list childrens name and grade they will be starting in the fall of 2010 below.
Please list childrens name and grade they will be starting in the fall of 2010 below.
Child #1
Child #2
Child #3
7
. We are interested in the following:
We are interested in the following:
Before School Care
After School Care
Both Before and After School Care
Full Day Care (weekdays when school is not is session, held at the YMCA)
8
. We anticipate utilizing this service as follows:
We anticipate utilizing this service as follows:
On a scheduled, weekly basis throughout the school year
On an intermittent, occasional basis as needed
Rarely, only in the case of an emergency
9
. Please contact me in regard to the following comments/questions:
Please contact me in regard to the following comments/questions:
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