After School Registration

Please fill out form completely. Fields marked with * are required.

Start Date: *

Child Name: *

Child Age: *

Child's DOB:

School:

Mother/Guardian Name: *

Mother/Guardian Email: *

Mother/Guardian Phone Number: *

Father/Guardian Name:

Father/Guardian Email:

Father/Guardian Phone Number:

After School Plan: (Select One) *
After School Plus ($85 /week)After School Basic ($80 /week)Before School Care ($70 /week)Before & After School Care ($145 /week)School Days Off ($37.50 /day)Half Day Care ($25 /day)Year Around Program ($100 /week)*

*Only available to ELC Clients. Subject to one year contract with two weeks vacation.

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7081 N Pine Island Road
Tamarac, Florida 33321

954-746-KIDS (5437)

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