Extended Care Registration 2018/2019
Have you used our Extended Care program previously? *
Mother's first and last name: *
Your answer
Father's first and last name *
Your answer
Email address *
The primary household email address for the family, which will receive important notices from our program.
Your answer
We will be using Extended Care for: *
Please check all that apply
Persons other than you who are authorized to pick up your children
Please include the full name and relationship to your child(ren).
Your answer
Family ID #
This can be found in your FACTS family profile, and it is also the same as your church envelope number, if you are registered with St. Juliana Parish. If unsure, please leave blank.
Your answer
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