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Before/After Care Application 2020-2021
Child's Name *
DOB *
MM
/
DD
/
YYYY
Classroom Name
2nd Child Name
2nd Child DOB
MM
/
DD
/
YYYY
2nd Child's Classroom Name
Parent's First & Last Name *
Parent Phone *
Parent Email
2nd Parent's First & Last Name
2nd Parent Phone
2nd Parent Email
Please choose the day(s) you would like Before Care services for your child *
Required
Please provide the times you will pickup your child from After Care, and note if times will vary per weekday
Please provide the day(s) and times that you will pick your child up from After Care *
3:15 - 3:30 pm
3:31 - 4:00 pm
4:01 - 4:30 pm
4:31 - 5:00 pm
5:01 - 5:30 pm
Will Not Use After Care
Monday
Tuesday
Wednesday
Thursday
Friday
Does your child have a care plan on file with Bridgeway Academy? (A care plan is required if your child has allergies or other health concerns.) *
Please list your child's interests (activities and toys your child enjoys)
Please list any questions or concerns
By selecting "yes", I acknowledge that I received and read the policy updated 7/22/19 and the fees associated with Before and After Care services at Bridgeway Academy. *
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