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            NEW SPEECH KIDS  AFTER SCHOOL CARE
NOW OFFERING HOMESCHOOL SUPPORT SERVICES!

                                                                                               ONLINE REGISTRATION FORM

NEW SPEECH KIDS

CLUB

REGISTRATION FORM
Need Help?  LiVe Chat NOW by clicking the "Let's Chat" icon!
 

REGISTRATION TUTOR

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* 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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