Interest List for Camp Fire Afterschool Care at Center for Children & Families

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* 1. Parent/Guardian's Name

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* 2. Parent/Guardian's Email Address

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* 3. Parent/Guardian's Phone Number

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* 4. Child's Name

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* 5. Child's Date of Birth

Date / Time

Date

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* 6. What program does your child currently attend during school hours at the Center for Children & Families?

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* 7. If your child participates in Camp Fire's Afterschool Care program, what time will you usually pick them up?

Will usually pick-up by 3:30pm

Will usually pick-up by 4:00pm

Will usually pick-up by 4:30pm

Will usually pick-up by 5:00pm

Will usually pick-up by 5:30pm

Will usually pick-up by 6:00pm

Will usually pick-up later than 6pm