Washington Irving Before & After Care Program 2020-2021 Application
Washington Irving Elementary School
18101 N Western Ave
Edmond, OK 73012
Nancy Priddy, Co-Director
LaDonna Crampton, Co-Director
Child #1 - Name *
Child #1 - Grade *
Child #1 - Date of Birth *
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Child #2 - Name
Child #2 - Grade
Clear selection
Child #2 - Date of Birth
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DD
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YYYY
Child #3 - Name
Child #3 - Grade
Clear selection
Child #3 - Date of Birth
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DD
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YYYY
Parent/Guardian #1 Name *
Parent/Guardian #1 Work phone *
Parent/Guardian #1 Cell phone *
Parent/Guardian #1 Email address *
Parent/Guardian #2 Name
Parent/Guardian #2 Work phone
Parent/Guardian #2 Cell phone
Parent/Guardian #2 Email address
My Child will attend the program during the following days and times: *
Before Only (7:00-7:55)
After Only (3:15 - 6:00)
Before AND After (7:00-7:55; 3:15-6:00)
Not attend the program on this day
Monday
Tuesday
Wednesday
Thursday
Friday
Please type your initials below the following statements regarding our program and its procedures.
Attendance: I am aware that I am required to sign up for a certain amount of days for the week. The number of days and/or the particular days that my child signs up for MAY NOT vary from week to week. I must commit to paying for all of the days that I sign up for, regardless of whether my child attends or not. I will not be charged for school wide holidays or snow days. *
Withdrawing from the program: I am aware that if I withdraw my child from the Before and After Care Program without notifying the Director, and not giving a 2 week notice, my child WILL NOT be readmitted for the remainder of the school year. *
Program Hours: I am aware that the After Care Program closes at 6:00 pm. If I repeatedly arrive after 6:00 pm, (more than 3 occurrences), I will incur a late fee of $1.00 per minute and the 5 minute courtesy will be waived for the remainder of the school year. *
Payment: I am aware that payment is due at the first of the month regardless of what day my child attends. I also understand that if payment is not received by close of after care on the 15th, I will be charged a late payment fee of $15, in addition to my program fees. *
The purpose of our procedures and policies is to be helpful and usable, and to strengthen our partnership with you. Please type your name and today's date, stating that you have read and agree to the condition of our procedures and policies. *
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