Super Kids' Place Registration Form (Jones)

Child's Name ___________________________________________

Date of Birth ____________________________________________

Date of Enrollment____________________ Grade________________

Home Phone_____________Work Phone________ Cell Phone _________

Parent's name(s)_____________________________________________

Address _____________________________________________

_____________________________________ ___

E-mail address

Indicate which program your child(ren) are registering for:

Before School (5day)______After School (5day) Both (5day)

Before School (3day) circle M T W Th F
After School (3day) circle M T W Th F
Both (3day) circle M T W Th F


I would like to register my children for enrollment in the program. I have attached the $60.00 non-refundable registration fee.
Director: Erika Yaruta-Roskam
Email to: ​Jonessuperkids@gmail.com
Super Kids Place
122 Hoyle Lane
Severna Park, Md 21146