‘Triad Kid Care’

“Your best choice for after school and summer care!”

Student 1 Name ____________________________ Age ______ D.O.B. ____/____/____ Grade _____

Student 2 Name ____________________________ Age ______ D.O.B. ____/____/____ Grade _____

Student 3 Name ____________________________ Age ______ D.O.B. ____/____/____ Grade _____

Address ______________________________City _____________________ Zip __________

Phone ______________________  Cell Phone ___________________ Email: __________________________

Mother/Guardian’s Name ____________________    Father/Guardian’s Name ____________________

School:_________________________________________________

School Dismissal Time:____________________
 

Please circle time needed:   After School 

Please return this form with your $25 registration fee before May 31, 2007
to reserve your spot for the 2007-2008 school year.

Triad Kids Campus 2202 SE Creekview Dr, Ankeny, IA 50021  www.triadgymnastics.com

                                                      Email Stephanie Kipling with questions at triadtlc1@aol.com