CURTIS AFTER~ SCHOOL
RECERATION & ENRICHMENT PROGRAM
REGISTRATION FORM
DATE_____________________
CHILD’S NAME
__________________________________________________ GRADE
___________________
TEACHER’S NAME ______________________________________________ ROOM # ___________________
PARENT / GUARDIAN
NAME___________________________________________________________________
ADDRESS___________________________________________________________________________________
HOME PH #________________________ CELL
#_________________________ WORK #____________________
E-MAIL__________________________________________
I AM REGISTERING MY CHILD FOR THE FOLLOWING
SESSIONS /DAYS
AUG 30,2006 – DEC 1, 2006_______ DEC 4, 2006 – MAR 30, 2007_______ APRIL 2, 2007 – LAST DAY OF
SCHOOL______
MON_______
TUES_______ WED______ THURS______ FRI______
---------------------------------------------------------------------------------------------
ADDITIONAL CHILD’S
NAME________________________________________________ GRADE____________
TEACHER’S
NAME__________________________________________________________ROOM
#___________
I AM REGISTERING MY CHILD FOR THE FOLLOWING
SESSION’S / DAYS
AUG 30,2006 – DEC 1, 2006_______ DEC 4, 2006 – MAR 30,
2007_______ APRIL 2, 2007 – LAST
DAY OF SCHOOL______
MON______
TUES_____ WED_____ THURS______ FRI______
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ADDITIONAL
CHILD’S NAME
_______________________________________________ GRADE_____________
TEACHER’S
NAME_________________________________________________________ROOM #____________
I AM REGISTERING MY CHILD FOR THE FOLLOWING
SESSION’S / DAY’S
AUG 30,2006 – DEC 1, 2006_______ DEC 4, 2006 – MAR 30,
2007_______ APRIL 2, 2007 – LAST
DAY OF SCHOOL______
MON _____
TUES_____ WED_____ THURS______ FRI______
PLEASE
NOTE THERE IS A NON-REFUNDABLE ANNUAL REGISTRATION FEE OF $25.00 PER CHILD DUE
UPON REGISTRATION.COST OF THE PROGRAM IS $15.00 PER DAY. SIBLINGS ARE AN
ADDITIONAL $12.00 PER DAY. YOU MAY MAKE YOUR CHECKS PAYABLE TO CURTIS OR CARE
EITHER ONE IS FINE.PAYMENT IS DUE AT THE BEGINNING OF THE WEEK, FOR THAT WEEK.
YOU WILL BE GIVEN A RECEIPT FOR YOUR RECORDS. IF PAYMENT IS NOT RECEIVED YOUR
CHILD WILL NOT BE ABLE TO ATTEND
UNTIL PAYMENT IS MADE. PLEASE RETURN THE REGISTRATION FORM & PAYMENT TO
CURTIS ELEMENTARY SCHOOL EITHER IN PERSON OR BY MAIL TO : C.A.R.E C/O CURTIS
ELEMENTARY SCHOOL , 582 BENEFIT ST. PAWTUCKET, R.I. 02861 ATTN: TRACY PROVOYEUR
CURTIS
AFTER SCHOOL REC & ENRICHMENT PROGRAM
FLORA
S. CURTIS ELEMENTARY SCHOOL, 582 BENEFIT ST. PAWT, R.I. 02861 PHONE -
401-729-6252 / FAX – 401-721-2100