Be Cool Before School
Registration form
Child’s
Name___________________
Teacher__________________
Address______________________________________
Parent/Guardian________________________________
Emergency contact
#____________________________
Please circle days
of week coming to program
Monday Tuesday Wednesday
Thursday Friday
Payment due at
time of registration Payable to: After School Program PS 196
One day a week is $100.00
Two days a week is $200.00
Three days a week is $300.00
Four days a week is $360.00
Five days a week is $410.00
Check out our website for more information sign up on line
www.becoolatafterschool.com