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CRA Hampstead and Sandown after
school course registration form
Parent/Guardian Name:______________________________________ Home
Phone:________________________
Address:_________________________________________Town:___________________________
zip:_________
Email
Address:_____________________________________________ confirmation choice:
____email ____phone
1st Child
Name:______________________________ 2nd
Child Name:________________________________
Age:
_____Grade:__________
Age: _____ Grade:__________
Parents will be sent
a notice when payment is due each month Parents will be sent a
notice when payment is due each month
Hampstead After School Classes
Cr
Craft - HC
7 8
9A 9B
10 11
12 13
@ $10 ea Weds
Craft - HC
7 8
9A 9B
10 11
12 13
@ $10 ea Weds
KI KITH- HK
14 15
16 17
18 19
20
@ $12 ea Thurs
KITK - HK
14 15
16 17
18 19
20
@ $12 ea Thurs
Sandown Craft
Classes
SN
SN 12
13 14
15 16
17 18
19 20
21
SN
12 13
14 15
16 17
18 19
20 21
22
23
24
25
26
27
28
29
30
$10/per class
22
23
24
25
26
27
28
29
30
$10/per class
(Please circle which ones you would like)
(Please circle which ones you would like)
Any Special
Educational needs? ___________________________ Any Special
Educational needs? _____________________________
Payment Info:
Check #: _____Check Amount: ________ Emergency Contact:
Name_________________________ Phone: ___________________
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