KIDS STUFF CENTER 2005/2006 REGISTRATION GRADES 4 � 6

							KIDS STUFF CENTER               2007/2008             REGISTRATION              GRADES 4 – 6

Please check the plan you want and PRINT NEATLY! Costs are based on 10 equal monthly
payments.
Tuition is due the 1st of each month and LATE after the 5th of the month.
_____5 Days (before & after school)…$395.00
_____5 Days (after school only).….…..$375.00                          -Office Use Only-
_____4 Days (after school only)…...….$350.00     Grade _______ Teacher _______________________
_____3 Days (after school only)..….….$325.00     Date Registered ______________ $50.00 fee paid ___
_____2 Days (after school only)..….….$300.00     Check # ____________ Cash ___________
_____MORNING ONLY ………..…...$130.00               Staff Initials _____________
     (7:00 am - 8:15 am)

Days attending: Mon _____ Tue _____ Wed _____ Thurs _____ Fri _____

A $50.00, non-refundable registration fee (per family) is required at the time of Registration.
(NO FORMS WILL BE TAKEN WITHOUT THIS FEE).

CHILD’S NAME ____________________________________ Birth Date ________________

Mother’s Name _______________________________________ Cell # ___________________
Address ______________________________Zip Code________ Home # _________________
Employer ____________________________________________ Work # __________________
E-Mail Address ________________________________________________________________

Father’s Name _________________________________________ Cell # _________________
Address _____________________________ Zip Code _________ Home # _______________
Employer _____________________________________________ Work # ________________
E-Mail Address _______________________________________________________________

EMERGENCY CONTACTS WHO MAY PICK UP MY CHILD:
Name ________________________ Relationship _______________ Phone # _____________
Name ________________________ Relationship _______________ Phone # _____________

PERMISSION TO RELEASE CHILD TO SIBLING:
Name ________________________ Age ______ Parent Signature ______________________

PERMISSION FOR MY CHILD TO SIGN HIM/HERSELF IN/OUT:
I give ____________________permission to sign in or out of Kids Stuff Center. Signing out
will NOT be permitted without a phone call or written instructions each day as to the time my
child can leave.           Parent Signature _______________________________________

Any special medical, allergy or behavior problems: __________________________________
______________________________________________________________________________
In the event parent or designated contacts cannot be reached, personnel of Kids Stuff Center are
authorized to use their discretion to secure medical aid.   Yes ___     No ___

Parent Signature ________________________________________ Date _________________