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Afterschool Pre-Registration Form

Please complete the form below. Once you have completed the form, you are free to join us the very next day. Just come in a let us know that you have filled out the online application.

First name*

Last name

Relationship to Child

Email

Phone*

Address

Name of child

Age of Child*

6-8

9-10

11-13

Do you have HRA/ACS Childcare Voucher? *

Yes

No

Does your child need pick up from their school? If so, what is the name of the school and address?

Emergency Contact Name:

Emergency Contact Number

The Haus NYC

MAIN LINE: (718) 764-0134
TEXT SUPPORT: (845) 671-5859

info@thehaus.nyc

©2017 by THE HAUS NYC

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