2020-2021 Extended Care Enrollment/Change Form
Important Reminders
1. Charges for any Extended Care options are in addition to the regular tuition payments.
2. Extended Care charges are billed monthly September through June.
3. Extended care changes will become effective the 1st of the following month.
4. There will be a $30.00 fee for changing the Extended Care plan option after September 2.
5. Extended Care plan rates are not prorated. If you will be changing to a different plan option, please submit the change BEFORE the first of the month that the change is needed. The Extended Care Enrollment Form is used for this purpose.
6. If there is inclement weather after school hours and you are delayed picking up your child because of extended travel times, no credit will be given for Extended Care charges.
7. For each minute after 6:00 p.m., a rate of $1.00 per minute/per student will be charged to the parent or guardian picking up a child late from Extended Care.
Student Information
Student's First Name *
Student's Last Name *
Student's Grade *
Teacher's Name
Extended Care Changes
Please choose which Extended Care Option you want for your student.
* By cancelling your Extended Care plan, please understand that the Extended Care program can be used on an "as needed" basis for a fee of $8.70 per hour.
Early Morning Care
Clear selection
Afternoon Care
Clear selection
Nap Option (Pre-Kindergarten Only)
All Full-Day Pre-Kindergarten students must choose a nap option.
All Full-Day Preschool students are required to take a nap.
A fee of $12.00 will be added to your bill for a nap cot sheet.
Nap Options
Clear selection
Date of Extended Care Change
Please select the start date for the change you are requesting above.
Start Date *
MM
/
DD
/
YYYY
Pick-Up Permission
The following individual(s) may pick up my child(ren) from Extended Care.
Name of First Individual (First and Last Name)
Name of Second Individual (First and Last Name)
Non-Medical Information
Parents are responsible for providing food substitutions for lunch, snacks, etc.
Dietary Restrictions
Parental/Guardian Approval
By typing your name on the line below, you are acknowledging that you are the parent/guardian and approve the information given on this form.
Parent/Guardian's First and Last Name *
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