Reisterstown Youth, "The Spot" Application

                              Reisterstown Youth, Inc.
                       The Spot Application Form
                     For School Year _____ to _____

TUITION: $200 per month
Please fill out this form completely online and then hit the "Print" button at the bottom of the page.
Student Information
First Name	Last Name		Male Female		DOB	Grade

Street Address			City		State	Zip

Name of School	Days Your Child Will Attend - Check all that apply
	Monday	Tuesday	Wednesday	Thursday	Friday

	(Monthly tuition applies regardless of the number of days student does not attend due to absence)

Mother/Guardian Information
First Name	Last Name		E-mail

Street Address (if different from student)			City		State	Zip

Home Phone	Work Phone		Cell Phone


Father/Guardian Information
First Name	Last Name		E-mail

Street Address (if different from student)			City		State	Zip

Home Phone	Work Phone		Cell Phone


Pick--Up Authorization Information (your child will only be released to persons listed below)
First Name	Last Name		ADDRESS			DOB

First Name	Last Name		ADDRESS			DOB


Emergency Contact Information
Name and Relationship			Phone		Alt Phone

Name and Relationship			Phone		Alt Phone


Does Your Child Have Allergies? Yes____ No _____ If Yes, please specify _________________________________
Does Your Child Have Special Needs? Yes____ No _____ If Yes, please specify _________________________________
Student's Interests (Please indicate your child's three greatest areas of interest:
Computers	The Arts		Cooking		Sports


Please list comments or special needs your child may have below:

308 Main Street, Historic Reisterstown, Maryland, 21136
Phone: 410-526-9521 E-mail: ReisterstownYouth@gmail.com