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Registration Information Request Form

Thank you for your interest in The Meeting House Afterschool for your child. If you are interested in more information about attending our afterschool program please fill out the following contact form. Our program administer will respond to you promptly to provide additonal specifics about the program activities, our schedule, fees and answer any questions that you may have.

Parent Information

First Name (parent #1): *

Last Name (parent #1): *

First Name (parent #2):

Last Name (parent #2):

Address: *

City: *

State: *

Zip Code: *

Phone (Home): *

Phone (Work):

Phone (Cell):

Email Address (primary): *

Email Address (second):

Child's Information

First Name: *

Last Name: *

Date of Birth: *

Age:

Gender: *

School:

Grade:

Guardian Name:

Guardian Phone:

Pediatrician:

Phone:

List Allergies or Medical Issues:

Therapies, if any?:

OT

ST

PT

BT

Other

Your Child's Strengths:

General Information

Goals For Your Child:

Conversation skills

Socializing in a group

Building Friendships

Other

Weekday you are interested in?:

Tue

Wed

Thu

Other

How Did You Hear About Us ?:

Please share with us anything else you would like us to know:

Registration Is Open

The Meeting House offers ongoing admissions for all our afternoon classes. You can start at your convenience. Interested families are welcome to join at any time during our year and rates are adjusted on a pro-rata basis. For more information download the documents below or call our program administrator at 212-355-1908.

Information brochure »
Registration forms and information »
Letter To Prospective Families »
Spring 2011 Newsletter »

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