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            NEW SPEECH KIDS  AFTER SCHOOL CARE

                                                                                               ONLINE REGISTRATION FORM

NEW SPEECH KIDS

CLUB

REGISTRATION FORM
Need Help?  Call or LiVe Chat @ 1 (855)553-0503 
 

REGISTRATION TUTOR

* COMPLETE THIS FORM FOR EACH CHILD

*ENTER THE CHILD'S ENTIRE NAME                                   

* ENTER PARENT OR GUARDIAN EMAIL ADDRESS

* IN THE REGISTRATION INFORMATION BLOCK ENTER INFO BELOW:

1. Start Date

2. Number of Children need care

3. Payment Schedule

(Weekly, Biweekly, or Monthly)

4. Medical concerns: Allergies on meds etc.

5. EXPECTED DROP-OFF TIME

6. EXPECTED PICK-UP TIME

7. YES or NO If your child or children may participate in fieldtrips, pics, & videos (specify any NO answers)

8. Note any additional INFO you would like to add. 

 

 

Name*

Email Address*

Registration Information*

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