HDS Extended Day Care Program Registration
Hancock Families wishing to enroll their children in our monthly program will need to register below - one form per child. You are only required to complete this form once during the school year. If you need to make a change to your enrollment please email Madison Mannarino (mmannarino@hancockdayschool.org).

Sign in to Google to save your progress. Learn more
Email *
Student's Full Name (Last, First) *
* One form per student
Enrollment Options *
Required
Months Needed *
Required
Grade Level *
Mother's Name, Phone Number, Email Address *
Father's Name, Phone Number, Email Address *
Emergency Contact Name, Relationship, Phone Number *
Is there anyone unauthorized to pick up your child? *
Student Allergies *
PLEASE READ BEFORE INITIALING. This document serves as an agreement between Hancock Day School and the Parent(s)/Guardians of the child indicated on the above registration.  My child will attend Hancock Day School’s Extended program. I agree to pay the fees associated with the service provided to my family on a monthly basis. I understand that after 5:30 PM I will be charged an additional fee calculated by the minute by the Extended program staff.  I understand that it is the policy of HDS and the Extended program not to allow my child to leave the school unless escorted by an approved adult indicated on my registration form. I agree that when picking up my child I, or the person I have authorized, will personally come and receive my child from the staff member in charge. I understand that my child must be signed out on the designated log at the time of departure.  At no time will I pick up my child without first making my presence known to the staff member.  I agree to notify HDS in writing immediately of any changes that occur in the information provided on the registration form, including work and home address, phone numbers, change in health information, change in emergency contacts, etc. In case of an emergency, if medical attention is required for my child before I can be contacted, I authorize the Extended staff to act on my behalf by contacting medical emergency personnel and following their advice for my child.  Please initial below. *
PLEASE READ BEFORE INITIALING. Monthly fees are not prorated for partial months or unused days. If you wish to cancel monthly service you must do so in writing 30 days in advance of monthly billing. Any fees incurred prior to the notice are the participants’ sole responsibility.  Please initial below. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Hancock Day School. Report Abuse