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MEMORIAL REGISTER & PAY

PARENTS INFORMATION

1. Parent's First name*

1. Parent's Last name*

2. Parent's First name*

2. Parent's Last name*

E-mail*

Phone*

STUDENT'S INFORMATION

School Name*

Memorial Elementary

PLEASE FILL OUT ALL INFORMATION FOR YOUR CHILD: I understand that if I leave any fields blank (such as grade or teacher), the student will not be considered officially signed up.

Choose an option*

Extended Learning

Car Pick Up

Child's First Name*

Child's Last Name*

Grade*

Teacher Name*

Any Allergy's*

CHOOSE YOUR CLASS (STUDENT #1)

Hip-Hop (MON)$400

Ballet (THUR) $400

Cheer (TUE) $350

Folklorico (FRI)$350

Rad Art (FRI)$450

Kidreative Jewelry (WED)$450

STUDENT #2 INFORMATION

Choose an option

Extended Learning

Car Pick Up

Child's First Name #2

Child's Last Name #2

Grade

Teacher Name

Any Allergy's

CHOOSE YOUR CLASS (STUDENT #2)

Hip-Hop (MON)$400

Ballet (THUR) $400

Cheer (TUE) $350

Folklorico (FRI)$350

Rad Art (FRI)$450

Kidreative Jewelry (WED)$450

STUDENT #3 INFORMATION

Choose an option

Extended Learning

Car Pick Up

Child's First Name #3

Child's Last Name #3

Grade

Teacher Name

Any Allergy's

CHOOSE YOUR CLASS (STUDENT #3)

Hip-Hop (MON)$400

Ballet (THUR) $400

Cheer (TUE) $350

Folklorico (FRI)$350

Rad Art (FRI)$450

Kidreative Jewelry (WED)$450

AUTHORIZED STUDENT PICK UP

Be prepared to present your I.D. and school assigned car tag # for verification at the time of pick up.

For your child’s safety, they will only be released to the individuals listed below.

1. Authorized Parent Pick-up Name*

1. Authorized Parent Pick-up Contact #*

2. Authorized Parent Pick-up Name

2. Authorized Parent Pick-up Contact #

3. Authorized Parent Pick-up Name

3. Authorized Parent Pick-up Contact #

INTERESTED AND WOULD LIKE MORE DETAILS?

INTERESTED AND WOULD LIKE MORE DETAILS?*

Spring Break Class

Summer Camp

Weekend Enrichment

Monthly Newsletter

Not Interested

ANY QUESTIONS

Any Questions or Comments?

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EST. 2009

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