Registration Form for all Clubs

HANC 609 and ECC Clubs, Fall 2014

Please mail/drop off this form with your check to:                    Shani Herschberg

                                                                                                            230 Bedell Terrace

                                                                                                            West Hempstead, NY 11552

Last Name:                                                                                                                                                                                   

Home Phone #:                                                                                          Parent’s Cell #:                                                                                         

Please list any additional phone numbers you think we should 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:                                                     

609

Mondays                                                                                                            Tuesdays

[1]  soccer, boys and girls, grades K-2, $170                                                      [3]  baking, boys and girls, grades K-2, $95

[2]  yoga, girls, grades 3-6, $110                                                                                         

Wednesdays                                                                                                            Thursdays

[4]  sports for boys, grades 3-6, $90                                                                        [6]  indigenous art, 
                                                                                                                                 boys and girls grades 3-6, $215

[5]  jewelry making for girls, grades 4-6, $130                                                       [7]  Doodle Drawing ,

                                                                                                                                        boys and girls grades K-2, $200

Mondays, Tuesdays, Thursdays, AM

[8]  shira club, grades 2-6, $230

ECC

[8] music, movement and yoga on Mondays, $85

[9]  sports on Wednesdays, $120

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

Please use one form per family, any additional children can be put on the back of this form.  One check per family.

10% off second and cheaper club must be in the same building, one paid club at 609 gets 2nd club AT 609 10% off, same for ECC.