C.A.R.E.S. Registration Form

Posted November 17th, 2009 by mmueller

Date:  ___________________

Child’s Name    1.   ______________________________    Grade  ___________

                             2.    ______________________________    Grade  ___________

                             3.    ______________________________    Grade  ___________

 

Parent’s Name _________________________________

 

Street  ________________________________________

 

City  ________________________ Zip Code  _________

 

Email Address  _________________________________

 

Home Phone # ( ____ ) _____________                 Pager/Cell ______________

 

Work Phone # Mother  ( ____ ) ______________ Pager/Cell ______________

 

                           Father   ( ____ ) ______________ Pager/Cell ______________

 

Dismissal Time (check one)  ______ 5:30 PM    _______  4:30 PM

 

                                                     ______ 2:30 PM

 

If Part-Time, indicate Days of Week Desired (circle)

 

          Monday      Tuesday      Wednesday      Thursday      Friday

 

Please return this form to C.A.R.E.S. c/o Visitation BVM School, 190 North Trooper Road, Norristown, PA 19403 with the non-refundable registration fee ($50.00 per child or $75.00 per family).

 

 

Office Use     ________   ________   ________   ________   __________

 

Reg Paid          Chk No.         Amt.            Date              Cash       Money Order