Forms

After School Admission Form - Mountain House

CHILD INFORMATION

Name *

DOB *

Grade *

Address *

MOTHER'S INFORMATION

Name *

Email *

Phone *

FATHER'S INFORMATION

Name *

Email *

Phone *

WHO WILL PICKUP CHILD FROM CENTER

Name *

Phone

EMERGENCY CONTACT

Name *

Phone *

Special Comments Any Allergies How did you hear about us

PROGRAM DETAILS

Choose your program * Hot lunch option * Choose number of days in a week * Choose your payment terms *
One time Registration/Material Fees (non-refundable): $125