Mannix, frances k-program registration form- monday

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  • 1. 7 Addison Street Larchmont, NY 10538 914-833-2880 Kindergarten Enrichment 2012 Please use a separate registration form for each child. Child’s Name: _____________________________________________________________________ Teacher’s Name :_________________________ Exit Door:________________________________ (Chatsworth only) Date of Birth: _____________ Allergies: ________________________________________________ Email Address:____________________________________Contact Names_____________________ Cell: _______________________________ Home:________________________________________ Address___________________________________________________________________________ __________________________________________________________________________________________________ ---------------------------------------------------------------------------------------------------------------------------------------------------- 2013-2014 Monthly Dates – MONDAY’S October - 9/30, 10/7, 10/21, 10/28 - $120 or $136 with pizza lunch___________________________ November - 11/4, 11/18, 11/25 - $90 or $112 with pizza lunch _______________________________ December – 12/2, 12/9, 12/16 - $90 or $112 with pizza lunch________________________________ January – 1/6, 1/13, 1/27 - $90 or $112 with pizza lunch____________________________________