CLUBS Registration Form- HANC ECC- Spring 2015

HANC ECC, Spring 2015

Please mail/drop off this form with your check to:                    Avigail Wodinsky

                                                                                                            329 Collins Lane

                                                                                                            West Hempstead, NY 11552

Checks should be made out to HANC PTA.

Last Name:                                                                                                                                               

Please list up to 3 phone numbers of yours you'd like us to have:                                               

                                                                                                                                                           

Parent’s e-mail address:                                                                                                                       

Emergency Contact: (someone other than child’s parent):

Name:                                                                                                Phone #:                                               

Child #1

First Name:                                                            Grade:                                    Teacher/room #:                       

Clubs child is registering for:  (please list #s only):                                    

Medical Alerts:                       

           

Child #2

First Name:                                                            Grade:                                    Teacher/room #:                       

Clubs child is registering for:  (please list #s only):                                    

 Medical Alerts:                       

Mondays

[1]  music, movement and yoga, $100

Wednesdays

[2]  sports, $165

 Please e-mail any questions or requests to be parent volunteer to shani.herschberg@gmail.com.

10% off additional and cheaper club(s) must be in the same building, one paid club at 609 gets additional club(s) AT 609 10% off, same for ECC.

Unless you hear from a PTA representative, please consider your child registered when you submit your form and check.  When a club has met its minimum to run, you will receive an e-mail.  If we do not meet the minimum number of children needed to run the club, you will receive an e-mail indicating such and given an opportunity to register for a different, available club