Extended Care Form 2018-19
Student's First Name *
Your answer
Student's Last Name *
Your answer
Class *
Days and times care is needed
Before School (6:30am-7:45am)
Lunch and Nap (12:00pm-3:00pm)
After School/Evening (3:00pm-6:00pm)**
Monday
Tuesday
Wednesday
Thursday
Friday
Important Notices
**If you are late picking up your child after 6:00 p.m., there will be a $10.00 charge for the first five minutes and $5.00 for each minute after that.

Students staying past after-school activities (dance, gym, Spanish) will be charged extended day fees

DROP-INS MUST BE APPROVED ON AN INDIVIDUAL BASIS EACH DAY

Signature
Please sign this form by entering your name below
Your answer
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