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Pioneer Care: Before/After School Care
Please complete the registration form below. Contact Loraine Twiddy at lorainet@pioneersprings.org if you have questions.  Thank you for utilizing our services. 
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Students name *
parent info *
Grade/Teacher *
Allergies: *
Medications: *
Do you require before care, after care or both? *
Required
Please indicate the days you wish your child to attend (select all that apply): *
Required
Please note any concerns, if applicable.
Parent/Guardian 1 Information
Full Name: *
Phone(s): *
Work Phone:
Email: *
Parent/Guardian 2 Information
Full Name:
Home Phone:
Phone(s):
Work Phone:
Email:
Please list two people authorized to pick up your child other than the parent/guardian.
Authorized Person 1
Full Name: *
Relationship to Child: *
Cell Phone: *
Authorized Person 2
Full Name: *
Relationship to Child: *
Cell Phone: *
Pick Up Late Fee Policy:

All students are to be picked up by 5:30 pm, promptly.
If you pick up your child after 5:30 pm, there will be a $10.00 late fee. Additionally, there will be a $10.00 fee for every 10 minutes past 5:30 pm until you pick up your child. For example, if you do not pick up your child until 6:00 pm, a late fee will be $30.00. The late fee payment must be paid upon late pick up of your child on the day of the event. Repeated late pick up will result in your child's termination of attendance to this program.
We understand that traffic can be challenging, but we expect all children to be picked up on time. 

Payment Policy: 

Payments are due BEFORE the first school day of the month for the month ahead. There is a $5.00 late fee for every day that the payment is late.


Registration fees (non-refundable)
$35 for the first child; $20 for each additional child
Due at the time of registration

We look forward to having your children included in our program, and we appreciate your commitment to adhere to the program policies.

I agree to a commitment of 1 year to the PSCS BSC/ASC program, and agree to the pick up late policy, as well as the late fee policy. I also understand that payment is due BEFORE the first school day of each new month for the month ahead. There is a late fee of $5.00 PER CALENDAR DAY for each day that the payment is late.


The party agrees that to the extent they sign electronically, their electronic signature is the legally binding equivalent to their handwritten signature.

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