Before and After Care Registration

Email

Parent or Guardian Full Name

Primary Contact Email

Phone Number

Child's Full Name

Grade Level

Service Requested

Before Care (7:00 AM - 8:00 AM)

After Care (3:30 PM - 6:00 PM)

Days Required

Days Required

Before Care

After Care

Start Date

Are there any specific medical conditions or allergies we should be aware of?

Authorized Pick-Up Person (Other than parent)

Emergency Contact Name and Phone

I agree to the school policy regarding late pick-up fees and safety procedures. ($10/ half hour after 6 pm)

I agree

I do not agree