Super Kids' Place Registration Form (Belvedere)
Child's Name      ______________________________________________
Date of Birth       ______________________________________________
Date of Enrollment______________________Grade__________________
Home Phone_______________Work Phone_____________Cell Phone______________
E-Mail_________________________________________________________
Parent's name(S)_______________________________________________
Address_______________________________________________________________
Indicate which program you are interested in:
AM only______________   PM only ________________
Both AM and PM _______________________________
I would like to register my children for enrollment in the program. I have
attached the $60.00 non-refundable registration fee.
Email to: ​Belvederesuperkids@gmail.com
Super Kids Place 
360 Broadwater Rd
Arnold Md 21012
Director: Julie Glass / Caroline Lebo