After School Care Request
Christ the Lord Lutheran School (262-782-3040)

HOURS: 11:30 am - 5:30 pm; RATE PER HOUR: $5.00; Additional Sibling: $2.50. BILLING: Invoices are emailed on a monthly basis.

Please submit a separate request form per student.
Midweek Lenten Worship Services
Families attending the (4:30 p.m.) services are offered a discounted rate of $2.50 during the time-frame of (3:20 p.m. – 4:30 p.m.).
Parents are responsible to provide snack (nut-free) for their student.
Student Information
Last Name *
Your answer
First Name *
Your answer
Grade *
List any medical conditions, allergies, or special needs.
Your answer
Request
*
MM
/
DD
Expected pick-up time (approximate) *
Time
:
Misc Note
Your answer
Reoccurring Schedule Request
Indicate a specific schedule for your child care needs throughout the school year.

Submit a new request if your schedule changes.

Example: Mon thru Fri 4:30 pickup
Your answer
Parent/Guardian Information
Last Name *
Your answer
First Name *
Your answer
Primary Phone Number *
Your answer
Parent Volunteer *
Must be volunteer at date/time of child care request.
Other Person(s) to pick up student
(Other 1) First & Last Name
Your answer
(Other 1) Phone Number
Include area code
Your answer
(Other 1) Relation to Student
Your answer
(Other 2) First & Last Name
Your answer
(Other 2) Phone Number
Include area code
Your answer
(Other 2) Relation to Student
Your answer
Submit
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