Please fill out all information below: 

Student's Name *
Student's Name
Gender
Programs Available At: Maurice J. Tobin School: 7:30AM - 9:30AM (Before School) 4:10PM - 6:00PM (After School) 7:30AM - 6:00PM (Full Day, Vacation Week, Summer Programming) Ellis Elementary School: 7:00AM - 9:30AM (Before School) 4:10PM - 6:00PM (After School) Chittick Elementary School: 7:00AM - 8:30AM (Before School) 3:10PM - 6:30AM (After School) 7:30AM -6:30PM (Full Day, Vacation Week, Summer) Edison K-8 School: 7:00AM - 8:30AM (Before School) 3:10PM - 6:30AM (After School) 7:30AM -6:30PM (Full Day, Vacation Week, Summer) New School Starting Summer 2019 Up Academy Holland Monday - Friday (except Wed.) 3:30 PM - 6:00 PM Wednesday 12:30 - 6:30 PM New Schools Starting Fall 2019 Guild Elementary School 7:00AM - 8:30AM (Before School) 3:10PM - 6:30AM (After School) 7:30AM -6:30PM (Full Day, Vacation Week, Summer) We also offer 5-day, 3-day and 2-day schedule options.
Which days will student attend program?
Parent or Guardian Name *
Parent or Guardian Name
Emergency Contact 1
Emergency Contact 1
Emergency Contact 1 Primary Phone Number
Emergency Contact 1 Primary Phone Number
Emergency Contact 1 Secondary Phone Number
Emergency Contact 1 Secondary Phone Number
Emergency Contact 2
Emergency Contact 2
Emergency Contact 2 Primary Phone Number
Emergency Contact 2 Primary Phone Number
Emergency Contact 2 Secondary Phone Number
Emergency Contact 2 Secondary Phone Number
Is there anyone else who is authorized to pick up your child from the program?
Is there anyone else who is authorized to pick up your child from the program?
Authorized Pick Up Contact Phone Number
Authorized Pick Up Contact Phone Number
Doctor's Name
Doctor's Name
Dentist's Name
Dentist's Name
Dentist's Phone Number
Dentist's Phone Number