After School Care
PARENTS: Please complete one separate form for EACH CHILD in your household who will be participating in After School Care for the month of JUNE. ***Please note: the cost per child is $6/hour, rounded to the nearest :10 minutes***
Email address *
Name of parent/guardian completing form: *
Primary Contact Phone #
Child's Name: *
Child's Grade: *
What JUNE dates will your child be participating in After School at SACDS? *
Please select all that apply, and approximate pickup time:
Before 3 pm.
Between 3-4 pm.
Between 4-5 pm.
Between 5-6 pm.
Monday, June 1
Tuesday, June 2
Wednesday, June 3
Thursday, June 4
Friday, June 5
Monday, June 8
Tuesday, June 9
Wednesday, June 10
Thursday, June 11
Friday, June 12
Monday, June 15
Tuesday, June 16
Wednesday, June 17
Friday, June 19
Monday, June 22
Tuesday, June 23 (LAST DAY OF SCHOOL)
The following are days when there is either a shortened day or no classes scheduled. In the space below, please indicate the days and hours you will need child care on these days. To ensure appropriate staffing, please notify us no later than two weeks prior to the days listed below. We are only able to provide this program pending a minimum amount of children enrolled each day. *
Before 12 noon
Before 1 p.m.
Before 2 p.m.
Before 3 p.m
Before 4 p.m.
Before 5 p.m.
Before 6 p.m.
To Be Determined...
Please list the names of anyone who may be expected to pick up your child: *
Is there anything else you would like us to know about your child? *
Please list the names of any siblings who may also be participating in After School: *
Any other comments?
A copy of your responses will be emailed to the address you provided.
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