BASC Survey for 2020-2021 School Year
Email address *
Student Last Name
Student First Name
Clear selection
Age of Student
Please share any information about your child that would be helpful for us in our planning process
Elementary School Attending
Parent/Guardian Name
Relationship to Child
Parent/Guardian Phone Number
Parent/Guardian Email
Did your child attend BASC during the 2019-2020 school year?
Will you need childcare for the 2020-2021 school year?
Please indicate when you will need care.
Will your child attend school on the A schedule (Mon & Tues) or the B schedule (Thurs & Fri)?
Will you have a working phone number and a secondary contact number in the event your child becomes ill while in our care?
I understand that the BASC program will follow the same guidelines as the regular school day regarding social distancing, the wearing of masks, handwashing and other guidelines deemed necessary for the health and safety of students and staff.
Do you want to be emailed an enrollment form for childcare so you can register now paying the $25.00 registration fee? The enrollment form can be dropped off at your school or it can be mailed.
If you have any questions or need additional information, you may email You may also contact the office at your school to get contact information for your site coordinator if needed. This is not an enrollment form. Students who were enrolled last year in the BASC program will get priority. The enrollment form is required to enroll your child.
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This form was created inside of Alexander County Schools.