APPLICATION FORM

If registering for FALL 1 SESSION please PRINT and MAIL this form to: 112 Buchanan Dr., York, Pa, 17402
Please send a minimum of half your tuition with your application.

Child's name:
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Street address:
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City and ZIP code:
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Phone number:
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Emergency phone number:
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Child's age & birthdate & gender:
__________________________________________________________

Email Address:
__________________________________________________________

Any medical conditions we should be aware of?
__________________________________________________________

Parent's signature:
__________________________________________________________

Parent's name (please print):
__________________________________________________________

CLASS PREFERENCE
First choice(day & time):
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Second choice(day & time):
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Third choice(day & time):
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