Aftercare Sign-Up
Use this form to sign up for Aftercare for Saint Adalbert Catholic School for the 2021 - 2022 School Year
Email *
Parent / Guardian Full Name: *
Full Address of Family including apartment number, if applicable: *
Parent / Guardian Contact Phone Number #1: *
Parent / Guardian Contact Phone Number #2: *
Emergency Contact Phone Number and relationship to child #1: *
Emergency Contact Phone Number and relationship to child #2 *
Please list five people and their relationship to the child who are permitted to pick up your child(ren). If there are not five people who given permission, please write "N/A" in the remaining spaces. *
Name of Child #1 *
Grade Level of Child #1: *
Please list any allergies of Child #1: *
Name of Child #2:
Grade Level of Child #2:
Please list any allergies of Child #2:
Name of Child #3:
Grade Level of Child #3:
Please list any allergies of Child #3:
How do you intend to pay for Aftercare this year? Payments for Aftercare on due on the first Friday of each month prior to services beginning. *
Please check below indicating that you're read the following statement and your needed cost per family: I understand that Aftercare costs $75 per child for the full month and that family discounts are offered as outlined below. *
Please read the following statement and check the bullet-point indicating your knowledge of this statement: *
Required
Please read the following statement and check the bullet-point indicating your knowledge of this statement: *
Required
Please read the following statement and check the bullet-point indicating your knowledge of this statement: *
Required
Please read the following statement and check the bullet-point indicating your knowledge of this statement: *
Required
Please read the following statement and check the bullet-point indicating your knowledge of this statement: *
Required
I give Aftercare staff permission to use my child's image in photos or videos on the school website or in promotional images. *
I give permission for my child to participate in any additional Aftercare-based activities with community members, such as the library visiting, reading aides, college or high school tutors, or local company programs. *
Please enter the name of the person completing this form as well as today's date below: *
A copy of your responses will be emailed to the address you provided.
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