St. Lawrence School
231 Main Street
West Haven, Connecticut, 06516
Celebrating 93 Years of Educational Excellence
St. Lawrence After - School Program Registration Form
Student's Name (s) _________________________________ Entering Grade _________________
___________________________________Entering Grade __________________
___________________________________Entering Grade __________________
Child/ren lives with _________ Both Parents ______ Mother ______ Father ________ Other
Days Requested (Please circle request)
Monday Tuesday Wednesday Thursday Friday
Father/Guardian Mother/Guardian
Place of Employment Place of Employment
Address of Company Address of Company
Days Employed Days Employed
Hours Employed Hours Employed
Business Phone # Business Phone #
Home Phone # Home Phone #
Cell Phone # Cell Phone #
$25.00 Registration Fee enclosed: _________________________
___________________________________________
Parent signature