Extended Care Registration
Use this form only for occasional/short-term Extended Care registration. If Extended Care service is required in less than 24 hours, DO NOT USE THIS FORM but please email elaine@achildsplaceschool.com directly.
If you have a long-term, regular requirement lasting more than two weeks, a standing arrangement may be set up by contacting Elaine in the school office (elaine@achildsplaceschool.com/732-747-0141).
Extended Care base price is $10/hour charged in half hour increments with minimum of $10 per session. Discounted pricing is available by purchasing packages of hours in advance. See EXTENDED CARE page for details and contact ACP office to purchase.
Email address *
Name of Child *
Your answer
Name of Parent Registering Child *
Your answer
Name and Phone Number of Emergency Contact/Person Picking Up if Not Already Held on File
Your answer
Extended Care Requirement
Choose Early Care and/or After Care. Indicate the approximate drop-off/pick-up time as shown. Billing is based on actual arrival/pick-up time as specified in EXTENDED CARE Conditions of Use. If your plans change after submitting the form, we respectfully request that you give the office as much notice as possible.
Week Beginning: *
Please choose date of the Monday of the week you are requesting extended care
MM
/
DD
/
YYYY
Early Care Arrival Time
Please indicate approximate arrival time. The earliest is 7am. Billing is based on actual arrival. Please note that the minimum charge is $10 for each extended care session.
7:00am to 7:30am
7:30am to 8:00am
8:00am to 8:30am
8:30am to 8:50am
Monday
Tuesday
Wednesday
Thursday
Friday
After Care Pick-Up Time
Please indicate approximate pick-up time. The latest is 6:00pm. Billing is based on actual pick-up time. Please note that the minimum charge is $10 for each extended care session. Pick-up after 6:10pm will incur a minimum late fee of $20. See Extended Care information for details.
12:30pm to 1:00pm
1:00pm to 2:00pm
2:00pm to 3:00pm
3:00pm to 4:00pm
4:00pm to 5:00pm
5:00pm to 6:00pm
Monday
Tuesday
Wednesday
Thursday
Friday
Parent Acknowledgement *
By checking below I acknowledge the terms and conditions of use of the Extended Care service. See EXTENDED CARE page on website for details.
Thank you for registering your child for Extended Care
You will receive a confirmation email from the school office.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of A Childs Place School. Report Abuse