Our Lady of Mercy Academy

Park Ridge, NJ

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AFTER CARE REGISTRATION

- Admissions

PLEASE COMPLETE AND SUBMIT THE FOLLOWING FORM TO ENROLL YOUR CHILD IN OUR AFTER CARE PROGRAM
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- Family Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Child's Name Please enter valid data.
- Grade Please enter valid data.
- Child's Name Please enter valid data.
- Grade Please enter valid data.
- Please list an emergency contact in the event a parent in not able to be reached.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Please select the number of days you wish for your child(ren) to participate:
- 5 Days
- 4 Days
- 3 Days
- 2 Days
Total:

Submit

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