Before and After School Enrichment (BASE) Registration

Complete the form below to register your student for classes. Financial assistance is available - please complete the form, indicate “pay by check” but contact Principal Smith directly for more information.

Name of Student *
Name of Student
Name of parent/guardian *
Name of parent/guardian
Phone of parent/guardian *
Phone of parent/guardian
Phone of emergency contact *
Phone of emergency contact
Your child is required to have an EpiPen for any food allergies.
Name of V-O Program *
Payment *

Questions? Contact the Leadership for BASE

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Michelle Stewart, Co-Chair

 
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Audrey Siciliano, Co-Chair