MLEDP School Year Care Registration Forms 2018-2019 | Mt. Lebanon Extended Day Program (MLEDP)

A copy of your signed Registration Schedule Payment Agreement (RSPA) will be sent back to you.
We will fill in your weekly fee based upon your schedule selections.

Due to site capacity limitations set by the DHS (Department of Human Services), our enrollment process has always been on a first come, first served basis at our sites. So please, submit your enrollment forms as soon as possible.

Questions?: 412-343-1661

1
Current: Child Information
2
School Year Registration Schedule Payment Agreement
3
Parental Consent and Emergency Contact Form
4
Expectations Checklist
5
Minor Media Release
6
Final Payment Agreement
7
Complete

Fill All Required Fields

If a field is required, MLEDP is likely required to collect it. If the information does not apply to you, please enter N/A in the field.

Child's Name

First

Middle

Last

Birth Date

Re-order	Month	Date	Year	Weight	Operations
	Month	Date	Year Year	Item weight

Gender

Male

Female

Age

Child's Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Home Phone Number for Child

Grade Completed

School Attending