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
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