AHES After School Program – Al Huda Elementary School

Student Name*

First Middle Last

Student Grade & Section*

Parent Information

Primary Parent/Guardian's Email*

Secondary Parent/Guardian's Email

Phone Primary Parent/Guardian's Phone*

Phone Secondary Parent/Guardian's Phone

Emergency Contact Name*

First Last

Relation with student*

Emergency Contact Phone*

After School Care Fee

Price:

$185 per month

AHES After School Care Credit Card*

Card Details

Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.