Sacred Heart School

Sacred Heart School
250 High Street
Mt. Holly, NJ 08060
609-267-1728

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Extended Day Registration

- Please complete the form below to register for AM Care and/or EDP for the 2024-2025 school year.
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Student Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Grade
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Grade
  
  Please list the days of the week you will use the program (as best as possible)
  
  Parent Information
  
  Parent 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Emergency Contact: Please list a contact we can reach out to in the event of an emergency if you cannot be reached (if possible, please list 2)
  
  EMERGENCY CONTACT 1 REQUIRED Please fill out this field. Please enter valid data.
  
  Relation to Student Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  EMERGENCY CONTACT 2 Please enter valid data.
  
  Relation to Student Please enter valid data.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Email Please enter an email address.
  
  Does your child have any medical issues we should be aware of? REQUIRED Yes No Please fill out this field.
  
  If yes, please explain:
  
  Are there any custody or dismissal issues we should be aware of? REQUIRED Yes No Please fill out this field.
  
  I have read, understand, and agree to follow the policies in the Sacred Heart Extended Day Program.
  
  I Agree Please select this field.
  
  Completed by: Please enter valid data.
  
  Submit
  
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