New Field Tuition Based After School Program

* 1. Parent Name
Nombre del padre

* 2. Student Name
Nombre del estudiante

* 3. Grade Level
Grado

Kinder

First/ primero

Second/ segundo

Third/ tercero

Fourth/ cuarto

* 4. I am interested in tuition after school programs
Estoy interesado en un programa de cuota

5 days per week / 5 dias cada semana

2-3 days per week/ 2-3 dias cada semana

1 day per week/ un dia cada semana

* 5. My child is currently enrolled in another after school fee based program:
Mi estudiante esta en un programa de cuota en otro lugar

Yes

No

* 6. What is your primary email address?
su correo electronico

Address 1

* 7. I can financially commit to paying $80.00 per week for five days of aftercare for the full school
year
Puedo comprometerme a pagar $80.00 cada semana por un año escolar

Yes

No

Other

* 8. If other, what information do you need to share:
Qué más información quiere compartir?