Before/ After Care Registration
Morning care will be from 7:00 am-8:30 am (Children will then be dismissed to the school). After-care will be from 4:00 pm-6:00 pm. Please fill out the form below in its entirety. A $25 registration fee and 1st-month tuition is due at the time of registration. You will receive a PayPal invoice via email before the close of the day. Forms of payments are PayPal, Money orders, or Check.) Thank you so much for choosing Something to Build Upon.
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Email *
Child's First Name *
Child's Last Name *
Age *
Child's Address *
Child's School *
Child's Teacher *
Gade *
Classroom Number
Dietary Restrictions *
Food and Medical Allergies *please list all foods or medications your child cannot have *
Physician's Name * *
Physician's Phone Number * *
List any health conditions *
List any medications your child uses *
Mother's First Name *
Mother's Last Name *
Mother's Email *
Mother's Address *
Mother's Phone Number *
Father's First Name *
Father Last Name *
Father's Email Address
Father's Address
Father's Phone Number *
Which parents does your child live with? *
List all persons that may pick your child up. *
List any persons not allowed to be in contact with your child. *
Emergency Contact Name and Phone Number *
Who should receive the monthly invoices? * *
Will you be using Illinois Action for Children? *
Which service are you registering for? *
Payment *I understand that my deposit is non-refundable. You will receive a PayPal invoice within 2 business days. *
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