2022-2023 SJRS Child Care Enrollment Form
Hello and welcome new families, and welcome back returning families!  

Each NEW family is responsible for a $20.00 enrollment fee, along with your completed enrollment form.  Please submit only one form per family.  For RETURNING families, we require a new enrollment form each year (but no fee) in order to attend the SJRS Child Care program.  Cash or check (payable to SJRS) for the enrollment fee may be brought to the Main Office.

Our Program
SJRS Child Care begins each day with a choice of snack, homework time, and free playtime in the Child Care room, on the playground and in our cafeteria space. Our homework room allows the children from second grade through eighth grade to complete their studies in a quiet environment. We love spending time on the playground, weather permitting, so please send your child with appropriate gear for seasonal weather!

Hours 
Before-School Program:  7:30 AM – 8:30 AM
After-School Program:  2:45 PM – 5:30 PM

Fees
One Child - $5.00/hour
Two Children - $8.00/hour
Three Children - $10.00/hour

Billing and Payment
Families are responsible for signing their children OUT each afternoon with the time of departure. Bills will be emailed to families each week. If payment balances exceed two weeks of invoices, we will request that a payment is made in full. A $25.00 fee will be imposed for any returned checks.

If you have questions regarding the SJRS Child Care Program, please contact:
Rachel Reekie
(603) 357-0339
rreekie@stjosephkeene.org
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Email *
LAST Name of Your Child(ren) *
For each child you are registering, please provide:
FIRST Name
Grade in school
Date of Birth
*
Please share any special needs, allergies, or concerns for each child. *
Name of child(ren)'s physician *
Name of child(ren)'s dentist *
Mother/Guardian's FIRST Name *
Mother/Guardian's LAST Name *
Mother/Guardian's Address *
Mother/Guardian's Home Phone *
Mother/Guardian's Cell Phone *
Mother/Guardian's Work Phone
Mother/Guardian's Workplace/Employer
Father/Guardian's FIRST Name
Father/Guardian's LAST Name
Father/Guardian's Address
Father/Guardian's Home Phone
Father/Guardian's Cell Phone
Father/Guardian's Work Phone
Father/Guardian's Workplace/Employer
FIRST and LAST name of best emergency contact  *
Best emergency contact's Home Phone *
Best emergency contact's Cell and/or Work Phone *
Please list the names of any additional individuals who may pickup your child and their phone numbers. *
I understand that the above listed individuals may be requested to show proof of identification when picking up.  I further understand that if any doubt exists, then the Child Care staff may choose not to release my child and that I will be notified immediately. BY INPUTTING YOUR NAME, YOU AGREE TO THE ABOVE. *
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