EXTENDED DAY AM and PM SUPERVISION PROGRAM SIGN-UP FOR THE 2017-2018 SCHOOL YEAR
We have Extended Day AM and PM Supervision programs at Holy Spirit Catholic School, St. Francis of Assisi School and at both campuses at St. John the Evangelist/St. Pius X School. Extended Day AM times are from (Holy Spirit may be opening earlier) 7:15 am - 8:20 am and Extended Day PM times are after school until 6:00 pm for students in kindergarten through grade eight. The fee for the Extended Day AM Supervision program is $7.00 per day/per student and the Extended Day PM Supervision is $9.00 per day/per student. Staffing is determined by the number of students signed up by May 5, 2017. There will be a $10.00 late fee for every five minutes that students are in the Extended Day PM program after 6:00 pm. Please use this form to sign up by May 5, 2017. Visit our website for additional information. Fees for the program will be billed through your SMART tuition account.
Family Name
ex: Smith
Your answer
School Attending
Required
Child 1 Name
Lastname, Firstname
Your answer
Child 1 Grade Level for the 2017-2018 School Year
Child 2 Name
Lastname, Firstname
Your answer
Child 2 Grade Level for the 2017-2018 School Year
Child 3 Name
Lastname, Firstname
Your answer
Child 3 Grade Level for the 2017-2018 School Year
Child 4 Name
Lastname, Firstname
Your answer
Child 4 Grade Level for the 2017-2018 School Year
Mother's Name
Lastname, Firstname
Your answer
Mother's Home Phone Number
Your answer
Mother's Work Phone Number
Your answer
Mother's Cell Phone Number
Your answer
Mother's Email Address
Your answer
Father's Name
Lastname, Firstname
Your answer
Father's Home Phone Number
Your answer
Father's Work Phone Number
Your answer
Father's Cell Phone Number
Your answer
Father's Email Address
Your answer
Name(s) and contact information to call in an event a parent(s) cannot be reached.
Your answer
Are there any health concerns for students attending the Extended Day Programs?
(please list information for each student - name and health concern)
Your answer
In the event an ambulance would need to be called I authorize RCS to have my child(ren) taken to
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