2020-2021 Wrens Club Registration

Please fill out this form for each child needing care by 9/4/20

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* 1. Student first/last name and grade:

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* 2. Is student assigned to the A group or the B group?

A

B

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* 3. Parent(s) Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 4. Does either parent classify as a tier 1 worker? If yes, please list your place of employment and job title:

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* 5. Known Allergies:

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* 6. Emergency Contact Name and Phone:

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* 7. Please list those authorized to pick up your child from Wrens Club:

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* 8. What days/times are you needing care? (We understand that some families have regular schedules and some have varied schedules. Please be as specific as possible for planning purposes and we will contact you prior to the first day of school to confirm your childcare schedule.)

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* 9. Please upload your schedule if possible

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Please read the following before proceeding:

2020-2021 Parent Handbook
2020-2021 Financial and Schedule of Care Agreement
2020-2021 Consent Form

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* 10. Please check the following if you agree:

I have read and agree to the parent handbook

I have read and agree to the financial and schedule agreement

I have read and agree to the consent form

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* 11. Please type your name as a signature below

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* 12. Please select the date:

Date

Date