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					           Bradford After-School Enrichment Program Application
Please complete and return by JANUARY 26 to be included in LOTTERY for classes.
Starting JANUARY 27 all applications will be on a first-come, first-served basis.
REQUIRED INFORMATION: Please provide all names, phone numbers & EMERGENCY CONTACTS
or your application will be returned. Please enclose your check made out to BRADFORD PTA for all
class choices requested (do not pay for alternates). See brochure for cost of each class.

PLEASE NOTE: There is NOT a nurse available during this program. If your child has a serious
medical condition this should be taken into consideration. A small snack and a bottle of water is
provided. If you have any concerns, please send in a special snack for your child.

Confirmations will be sent home as timely as possible, or you may e-mail

Student's Name:____________________________________Boy ( ) or Girl ( ) Grade: __________

DISMISSAL: Does student attend After-care program? NO___                 YES (please circle days) M Tu W F

Homeroom Teacher _____________________________________________                             Homeroom No. ________

Home Address: _______________________________________________________________________

Home Phone: __________________________ Email:_________________________________________

Parent/Caregiver's Name(s)__________________________________________________________

                                           Cell Phone(s):______________________
Daytime Phone Number(s):_______________________

REQUIRED Emergency Daytime Contacts & Phone Numbers (MUST be different than above info)

                                       Number(s): ___________________________________
Name: _____________________________________

                                       Number(s): ___________________________________
Name: _____________________________________

MONDAY               Class Choice: _____________________________________                              Fee: $________
                   Alternate Class: _____________________________________

TUESDAY              Class Choice: _____________________________________                              Fee: $________
                   Alternate Class: _____________________________________

WEDNESDAY Class Choice: _____________________________________                                         Fee: $________
                   Alternate Class: _____________________________________

FRIDAY               Class Choice: _____________________________________                              Fee: $________
                   Alternate Class: _____________________________________

Check made out to BRADFORD PTA enclosed for:                                   Total $_______________

           For applications turned in BEFORE JANUARY 27: If you are signing up for more than one class,
     list your 1st & 2nd choices. If you do not get your 1st choice, you will be given priority for your 2nd choice.
1st Choice: Day: _______________________ Class: ______________________________________
2nd Choice: Day: _______________________ Class: ______________________________________

If you have any questions please email or call Charlene @ 973/655-0900

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