2019-2020 Extended Day Form
Email address *
August 14th 2019 - June 3rd 2020
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number: *
Your answer
Name of Child #1 *
Your answer
Name of Child #2
Your answer
Name of Child #3
Your answer
Name of Child #4
Your answer
Extended Care Billing Rates per child are as follows: Registration fee is $25 per student.
There will be a $2.00 per minute charge for any student not picked up after 6:00 pm. FACTS Account will be charged every Monday for previous week.
By signing below, I acknowledge that I have read all of the above and agree to have the $25 per student registration fee charged to my FACTS account.
Parent Signature (Type Full Name Below) *
Your answer
Date Signed *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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