Extended Care Registration    
Extended Care is a program offered at the elementary campus for students in grades K5- 6th.  The hours are 2:30 – 5:30.     *An additional $10.00 fee will be charged for each 15 minutes after 5:30 p.m.

Extended Care Director  * Metha Wood * 601-264-9906

Sign in to Google to save your progress. Learn more
Email *
Student Name (First and Last) and Grade: *
Parent(s) Name (first & last)  & Cell Phone #: *
Will there be anyone other than student's parents picking up student? *
If so, please list names (first & last), cell phone #, and relationship to student (grandparent, aunt, babysitter, etc.).
Please choose Extended Care Option below:
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Presbyterian Christian School.

Does this form look suspicious? Report