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Cub Care Registration 2016-2017
Online registration form for 2016-2017 school year.
CHILD INFORMATION
Child's Name (First and Last)
Your answer
Child's Address (Street, City, State, Zip)
Your answer
Grade
School
Primary Contact Information
First Name and Last Name
Your answer
Relationship to Student
Your answer
Mailing Address: Street, City, State, Zip (if different from student)
Your answer
Cell Phone Number
Your answer
Home Phone Number
Your answer
Work/Other Number
Your answer
Email Address
Your answer
Secondary Contact Information
First Name and Last Name
Your answer
Relationship to Student
Your answer
Mailing Address: Street, City, State, Zip (if different from student)
Your answer
Cell Phone Number
Your answer
Home Phone Number
Your answer
Work/Other Number
Your answer
Email Address
Your answer
Cub Care Usage
How to do you plan to utilize Cub Care for your child? (select all that apply)
Are there any legal restrictions on who may pick up your child?
If yes, please explain (legal documents are required for court-ordered restrictions)
Your answer
EMERGENCY CONTACT INFORMATION
(If parent or guardian cannot be reached)
Emergency Contact #1 - Name
Your answer
Phone Number
Your answer
Emergency Contact #2 - Name
Your answer
Phone Number
Your answer
Emergency Contact #3 - Name
Your answer
Phone Number
Your answer
Persons Authorized to Pick-up Child (other than parent or guardian listed above)
Photo i.d. will be required upon pick-up and name must be on this list.
Name and Relationship
Your answer
Name and Relationship
Your answer
Name and Relationship
Your answer
Medical or Behavioral Issues
Please list any allergies, medications, and/or other issues about your child which we should know about.
Your answer
Cub Care Financial Agreement
I agree to pay the $20 family registration fee prior to the start of the school year. I can do this by mailing payment to Cub Care, 998 Grizzly Cub Drive, Franklin, IN 46131, online by creating an account with SchoolPay (instructions on Cub Care website), or by giving to current site leader of Cub Care program. I understand that the registration fee is non-refundable.

I understand that there will be a charge for Cub Care. I further understand that payments are to be made on a weekly or bi-weekly basis, per arrangement. Children attending the full week will be responsible for payment on Friday or every other Friday, per arrangement, for the week or weeks attended. Children attending on a daily basis will settle payment on last day of the week in attendance.

I understand that a $35.00 fee will be charged for any NSF check and I will not have the ability to pay by check until the matter is resolved. Any unpaid and unresolved balance due may be turned over to a collection agency. I understand that I will be responsible for payment of all additional collection fees.

It is very important that all children are picked up at the appropriate time. This can be a scary situation for a child who feels they have been forgotten. If your child is picked up late (after 6:00 p.m.), there will be a late pick up charge of $15 for each 15 minutes per child assessed.

My electronic signature below is my acknowledgement that I understand and agree to comply with all above stated terms and conditions. I further acknowledge and understand that I am responsible for the full amount of fees due.

Registration Payment
Electronic Signature of Responsible Parent/Guardian
Your answer
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