Children’s Aid Society - New York Charity for Children

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Please read the Early Childhood Registration Policies

Spring 2010
January 25th - May 28th

Student Info
First Name:	*
Last Name:	*
Address:	*
City:	*
State:	AL AK AR AZ CA CO CT DC DE FL GA HI ID IA IL IN KS KY LA MA MD ME MI MO MN MS MT NC ND NE NH NJ NM NY NV OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY intl.          Zip:*
Home Phone	*
Birth Date (mm/dd/yy):	//*	Sex: * male   female
School Name:		Grade:
Physician's Name:	*	*Tel:
Important Medical Information:
Parent/ Guardian Information
Parent/Guardian 1:	*	Cell:
Occupation:		Email:
Company:		W Phone:
Parent/Guardian 2:		Cell:
Occupation:		Email:
Company:		W Phone:
Sitter/Nanny:		Tel:
Emergency Contact (Other than parent):	*	*Tel:
Persons Authorized to Pick Up Child:
Name:	Relationship:	Phone number:
*	*	*
Available Courses Course Key Class Title Eligibility Day Offered Time Price 300 SP10Toddler Time 17-23months Monday 10:45-12:00 $500 301 SP10Toddler Time 23-29months Wednesday 9:00-10:30 $525 302 SP10Toddler Time 23-29months Thursday 10:45-12:15 $525 303 SP10Toddler Time 26-32months Friday 9:00-10:30 $525 304 SP10Toddler Time 29-35months Monday 9:00-10:30 $525 305 SP10Toddler Time 29-35months Wednesday 10:45-12:15 $525 306 SP10Toddler Time 29-35months Thursday 9:00-10:30 $525 307 SP10Toddler Time 29-35months Friday 10:45-12:15 $525 308 SP10Music & Art 30-36months Tuesday 9:15-10:30 $525 309 SP10Stepping Out 11-17months Tuesday 11:15-12:15 $475 Optional donation: Registration Fees Summer: $10, Spring and Fall: $25 Total (includes registration fee):
I have read and accept the terms of this registration [read terms]