I understand that I will not be able to use Before and/or After Care this year without completing this form, as required by our licensing agency. * *
Parent 1 first and last name: *
Your answer
Parent 2 first and last name: *
Your answer
Student(s) name(s): *
Your answer
I will use Before Care every week on the following days: *
Required
I will use After Care every week on the following days: *
Required
For After Care, I will most often pickup my child by the following time: *
Any additional information:
Your answer
I understand that my child will be automatically registered for the services selected above, every week. If this changes, I need to inform child care staff. *
Required
If my child will be absent from care for any reason, I need to let staff know as soon as possible to avoid charges. *
Required
If my child does not attend Child Care Services on a day they are registered for, I may be charged a $5 (per child) no show fee. *
Required
A copy of your responses will be emailed to the address you provided.