Lancaster 2021-2022 Extended Learning Registration
Welcome to the Extended Learning program's 2021-2022 school year registration for Lancaster students!
Please fill out this registration form to apply for a spot in our growing program. Registration closes on July 1st, 2021.

All successful registrations will be charged a $35 non-refundable registration fee to reserve your child's spot. You will see this bill in August when it will be sent to your email account associated with MySchoolBucks.com

Our billing is done through MySchoolBucks.com. Please create an account on their website to receive your electronic invoices. To cap your yearly fees, please consider signing up for a OnePay Membership.

All payments are due on the 28th of the previous month. Payments that are not processed by the 28th of the prior month will result in a $15.00 late free. Frequent missed payments will result in suspension from the program.

Please fill out a separate form for each child, we offer a 10% discount for each sibling.

Email Leah Botko lbotko@nrsd.net if you have any questions regarding billing or program questions.
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Email *
Child's First name *
Child's Last name *
School *
Grade *
Student DOB *
MM
/
DD
/
YYYY
Student Gender *
Attendance
Children thrive socially and academically in an environment that provides familiarity and routine. The Extended Learning program takes pride in providing this familiarity for our students. To maintain our students' routines and schedules, we encourage regular attendance.
Please let us know if your child will be absent via email by 7:30 am for AM program, or 2 pm for PM program.
*Failure to inform us of an absence from the program will result in a $10.00 fee.*
In emergency situations, parents may add days on a single basis for $7.00 (AM program) or $38.25 (PM program) per student. To request an extra day, please contact lbotko@nrsd.net AND complete an online change of schedule form, found on our website.
Schedule changes are allowed, as long as the change applies to the entire month. Schedule changes of less than one month in duration will not be considered and WILL NOT be prorated.
All schedule change requests after AUGUST 1ST will be assessed a $15.00 fee.

AM program days per week (7:25 - 8:25 AM) *
PM program days per week (3:00 - 6:00 PM) *
AM program days of attendance (starts 7:25 am) *
Required
PM program days of attendance (ends at 6 pm) *
Required
Parent and other contact information
Please provide the best way to reach you or other emergency contacts.
Parent First Name *
Parent Last Name *
Parent email *
Parent address *
Best phone number to reach parent in case of emergency *
Second best phone number to reach parent *
Alternative contact FIRST AND LAST NAME *
Alternative contact phone number *
Alternative contact relationship to student *
Alternative contact email (if they would like to receive communications)
Emergency contact FIRST AND LAST NAME *
Emergency contact phone number *
Student's relationship to emergency contact *
FIRST AND LAST name of alternative pick up person (must be over 18 and have valid ID) *
Alternative pick up person phone number *
Medical Information
Provide us with a detailed account of student medical information. Please note that there is NO NURSE ON DUTY during these hours. Our staff cannot administer medications, sun tan lotions, bug sprays, or any other over-the-counter products.
Does your child have a life threatening allergy? *
If so, please describe below
Does your student use an Epi-Pen? *
Does your child have a non-life threatening allergy? *
If yes, please describe
Does your child have any other medical conditions? (Check as many as apply) *
Required
Does your student take any medication that you would like staff to be aware of?
Physician name *
Physician address *
Physician phone number *
Dentist Name *
Dentist address *
Dentist phone number *
Social-emotional information
Please provide us with any information about your child's social emotional well-being so we may best attend to his or her individual needs. We have an open communication policy with our day schools which allows us to maintain effective, positive behaviors and learning strategies.
Does your student have an IEP, 504 or other special considerations? *
Required
Do you have any social/emotional concerns about your child?
Parent Permission Acknowledgments
Please initial below to sign off on each statement.
Please initial to approve student participation in Home Work Time *
Please initial to acknowledge that staff has access to IEP, 504, or any other specialized learning plan *
Please initial to approve student's participation in Friday movie day G or PG *
Please initial to approve student's participation in walking trips *
Please initial to approve student's participation in photographs (used for our website, Extended Learning Twitter, and local newspapers) *
Please initial that you understand our billing is done through MySchoolBucks.com. You will need to create an account for your student through the site. All bills will be sent electronically to your email. Payment is due on the 28th of each month August-May. You can waive all program fees for 12 months by signing up for a OnePay Membership, found under My User Profile. *
Please initial to acknowledge that there is no nurse on duty. Medications, sun screen, bug sprays etc. cannot be administered by Extended Learning staff. *
Please initial to acknowledge that the program will be running under CDC COVID-19 guidelines. Increases in cases or clusters may cause the program to close temporarily or long term. *
A copy of your responses will be emailed to the address you provided.
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