Extended Day Registration, 2019-2020
Please use this form to sign your child up for extended day care at Great River School. For program and rate information, please see www.greatriverschool.org/big-canoe-club

Payment of the registration fee of $20 reserves your child's spot in the program. After you fill out this form, you will receive an Email with payment information.

Please note that care begins on Tuesday, September 3, 2019.

What is the student's name?
Your answer
What is the student's grade?
Your answer
Who are the parents/guardians?
Your answer
What are the contact Email(s) for communication?
Your answer
What is the contact Email for billing?
Your answer
Please list parent phone contacts for use in case of emergency:
Your answer
Please list at least one other emergency contact phone number:
Your answer
Who can pick up this child from aftercare?
Your answer
Does the child have any allergies or medications we should be aware of?
Your answer
Please check all of the days that this child will need care BEFORE school
Please check all of the days that this child will need care AFTER school
Preferred payment schedule
What activities is your child interested in?
Your answer
Is there anything else we need to know?
Your answer
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