Harmony Student Care Application

Please understand that filling out this application does not automatically guarantee you a position. There is a $20 deposit required for each child. If you would like to pay the deposit online, you can do so. Please go to the give tab (above) and select the after school care program from the drop down menu.

PARENT INFORMATION
Parent's Name
Phone Number
Address
Email
Date you want your child/children to begin attending Harmony Student Care:
CHILD INFORMATION
Name
Child 1
Date of Birth
Child 1
Gender
- Male
- Female
Child 1
Name
Child 2
Date of Birth
Child 2
Gender
- Male
- Female
Child 2
Name
Child 3
Date of Birth
Child 3
Gender
- Male
- Female
Child 3
Name
Child 4
Date of Birth
Child 4
Gender
- Male
- Female
Child 4
Check which school your child/children attend
- LES
- Other
If other, please list here
Check which grade(s) your child/children are in
- K5
- 1st
- 2nd
- 3rd
- 4th
- 5th
- 6th
Please list the days and times needed.

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Harmony Student Care Application

PARENT INFORMATION

CHILD INFORMATION