After Care Sign Up - Cross Lanes Christian School

Child's Name

Grade

Address

City

State

Zip Code

Birthdate

Church

Parent's Names

Father's First Name

Father's Last Name

Mother's First Name

Mother's Last Name

Instructions on who is to pick up the child

Emergency Contact Phone

COST: $8.00 per hour | 3:30 pm – 6:00 pm

Any restrictions pertaining to activities or food?

Any allergies?

Special interests or hobbies?

Other helpful information?

I AGREE

I agree to all of the above.

After Care Sign-Up

Child's Name

First

Last

Grade

Address

Birth Date

Church

Parent's Names

Father's Name

First

Last

Instructions on who is to pick up the child:

Emergency Contact:

First

Last

Mother's Name

First

Last

Emergency Contact Phone

COST: $8.00 per hour | 3:30 pm – 6:00 pm

Any restrictions pertaining to activities or food?

Any allergies?

(List all known allergies)

Special interests or hobbies?

Other helpful information?

Signature

Date of Signature

If you are human, leave this field blank.

After Care Sign-Up

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Parent's Names

After Care Sign-Up

Parent's Names

Our Address

Opening Hours

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