Registration

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Name *

Surname *

Date of Birth

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Name 2nd child

Surname 2nd child

Date of Birth

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Name *

First

Last

Phone number

Email *

Adress

Adress Line 1

Adress Line 2

City

State/Province/Region

ZIP Code

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Please indicate here your potential need for the after-school care service (4:30 PM to 5:30 PM) :

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