Cub Care Registration 2018-2019
Online Cub Care registration form for 2018-2019 school year.
**Once registered, you must wait a full 2 business days to attend the program.**
We will need an individual form for each student!
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
Only above listed parents/guardians and the below authorized individuals listed will be allowed to pick up from Cub Care.(If parent or guardian cannot be reached)
Emergency Contact #1 - Name
Your answer
Relationship
Your answer
Phone Number
Your answer
Is this person allowed to pick child up?
Emergency Contact #2 - Name
Your answer
Relationship
Your answer
Phone Number
Your answer
Is this person allowed to pick child up?
Emergency Contact #3 - Name
Your answer
Relationship
Your answer
Phone Number
Your answer
Is this person allowed to pick child up?
Medical or Behavioral Issues
Please list any allergies, medications, and/or other issues about your child which we should know about. If any of this information pertains to the school day, it is your responsibility to contact your child's school to make the nurse aware of any medical condition(s) that may require attention.
Your answer
Medical Release Statement
I authorize the Cub Care staff to seek medical attention for my child in case of an emergency. My electronic signature below is my acknowledgement of this statement.
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. The program ends promptly each weekday at 6:00 pm It is very important that all children are picked up at the appropriate time. Late pick up fees will be assessed to any pick-ups after 6:05pm. The charge is $1 for each minute late per child.

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.

Cub Care Handbook Acknowledgement
I have read and understand all terms in the Cub Care Handbook. My electronic signature below is my acknowledgement that I and my student understand and agree to comply with all stated terms and conditions in the 2018-19 Cub Care Handbook.
Registration Payment
Electronic Signature of Responsible Parent/Guardian *
Your answer
Are you a Franklin Schools employee?
If you are a FCS employee, please list department/building.
Your answer
Submit
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