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Before/After Care
Name
(Required)
First
Last
Email
(Required)
Mother Cell Phone
Mother WorkPhone
Father Cell Phone
Father Work Phone
Names of Persons Authorized to Pick Up
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Remove
Medical
Add
Remove
Please list any medical info and applicable medications we will have on-hand.
Consent
(Required)
We/I grant permission for medical assistance to be secured for our/my child(ren) should it be and as deemed necessary by the supervisory staff.
Electronic Signature
(Required)
First
Last
Before Care Options
Mondays ($10/child)
Tuesdays ($10/child)
Wednesdays ($10/child)
Thursdays ($10/child)
Fridays($10/child)
Random
Before Care is available beginning at 7am. Please choose all applicable days.
After Care Options
Mondays pick up by 4:30pm ($15/child)
Mondays pick up after 4:30pm ($20/child)
Tuesdays pick up by 4:30pm ($15/child)
Tuesdays pick up after 4:30pm ($20/child)
Wednesdays pick up by 4:30pm ($15/child)
Wednesdays pick up after 4:30pm ($20/child)
Thursdays pick up by 4:30pm ($15/child)
Thursdays pick up after 4:30pm ($20/child)
Fridays pick up by 4:30pm ($15/child)
Fridays pick up after 4:30pm ($20/child)
Random
After Care is available until 6pm. Please choose all applicable days/times. Times are an estimate.
Consent
(Required)
I understand that pick up after 6:00pm will result in a $2/min late fee.
Student 1 Name
First
Last
Student 1 Grade
Choose One
PreK3
PreK4
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eight Grade
Student 2 Name
First
Last
Student 2 Grade
Choose One
PreK3
PreK4
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eight Grade
Student 3 Name
First
Last
Student 3 Grade
Choose One
PreK3
PreK4
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eight Grade
Payment will be processed through Smart Tuition
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