Patriot Advantage Club (PAC) Before & After School Program Registration for 2021-2022

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Please complete the following registration form for the NEW Bunker Hill CUSD#8 Before and After School Program-Patriot Advantage Club (PAC).

Click on this link to view the Patriot Advantage Club Program Handbook:
https://drive.google.com/file/d/1NQXFtb0ZoLuXB3YyTZujYRZVKeZG9feB/view?usp=sharing

Registration Fees:
Registration fees are $25 per family and are due following submission of the registration form.
Registration will not be considered complete until registration fees have been submitted. Fees can be mailed to or dropped off at BHCUSD#8 Unit Office at 504 East Warren Street Bunker Hill, IL 62014. Program enrollment will be on a first come, first serve basis and may require a waitlist upon reaching program capacity.

Following successful completion of registration and receipt of registration fees, you will be contacted to confirm program enrollment during the first week of August. If you have any questions, please call (618) 585-4831 or
e-mail sronen@bhcusd.org.

Payment Information:
Families will be invoiced monthly via their Teacher Ease account. Monthly program fees can be paid online via Teacher Ease using a credit card or by paying via check made out to Bunker Hill CUSD8. Fees should be paid by the first of each month for the following month. If fees are not paid in full by the 15th of each month for the following month, students will not be able to attend until fees are paid in full. If a check is returned due to insufficient funds, additional fees will apply.

Program Hours:
Before School - 6:00 a.m. - 8:00 a.m.
After School - 3:00 p.m. - 6:00 p.m.
Early Dismissal - Dismissal - 6:00 p.m.
Teacher Institute Days/Holiday Breaks - 6:00 a.m. - 6:00 p.m.

Program Calendar:
August 11, 2021 - Last Day of School on all student attendance days
In addition to the above, PAC will also be available for students on the following dates during school breaks and institute dates:
Fall Dates: 10/08/2021, 11/12/2021, and 11/24/2021
Winter Dates: 12/27/2021 - 12/30/2021 and 01/04/2021
Spring Dates: 4/11/2022 - 4/15/2022

Program Rates (Due on the 1st of each month):
Before School Only - $45/week
After School Only - $55/week
Before AND After School - $80/week
Full Day Care - $25/day

Multiple Child Discount: 10% discount for multiple children

Email *

Parent/Guardian #1 FIRST name: *

Parent/Guardian #1 LAST name: *

Parent/Guardian #1 Phone Number: *

Parent/Guardian & Student Address (Complete with house or apartment #, street, city, & zip) * *

Parent/Guardian #2 FIRST name: (optional)

Parent/Guardian #2 LAST name: (optional)

Parent/Guardian #2 Phone Number: (optional)

Parent/Guardian #2 Email: (optional)

I am registering the following number of children in the Bunker Hill CUSD8 Patriot Advantage Club Before & After School Program: *

Child #1 FIRST name: *

Child #1 LAST name: *

Child #1 Date of Birth: *

YYYY

Child #1 Grade Level Entering for the 2021-2022 School Year: *

List any known ALLERGIES for Child #1 Below or N/A if none. *

Child #2 FIRST name:

Child #2 LAST name:

Child #2 Date of Birth:

YYYY

Child #2 Grade Level Entering for the 2021-2022 School Year:

List any known ALLERGIES for Child #2 Below or N/A if none.

Child #3 FIRST name:

Child #3 LAST name:

Child #3 Date of Birth:

YYYY

Child #3 Grade Level Entering for the 2021-2022 School Year:

List any known ALLERGIES for Child #3 Below or N/A if none.

Child #4 FIRST name:

Child #4 LAST name:

Child #4 Date of Birth:

YYYY

Child #4 Grade Level Entering for the 2021-2022 School Year:

List any known ALLERGIES for Child #4 Below or N/A if none.

EMERGENCY CONTACT OTHER THAN PARENT/GUARDIAN #1 (First and Last Name/Relationship to Child/Phone Number) * *

EMERGENCY CONTACT OTHER THAN PARENT/GUARDIAN#2 (First and Last Name/Relationship to Child/Phone Number) * *

Patriot Advantage Club Options *

Before School Program ONLY - 6:00 AM - 8:00 AM ($45/week)

After School Program ONLY - 3:00 PM - 6:00 PM ($55/week)

Before & After School Program - ($80/week)

Full Day Care During Breaks and Teacher Institute Dates - 6:00AM-6:00PM ($25/day)

Required

I believe I meet the eligibility requirements and plan to apply for state subsidy through the IDHS Child Care Assistance Program (CCAP). Please click on the following link to learn more about CCAP eligibility requirements and to access the application: https://www.dhs.state.il.us/page.aspx?item=104995. The sooner you apply, the sooner benefits can be determined. * *

Yes

To indicate your acknowledgement and agreement, please check ALL of the the following program regulations regarding fees and procedures. *

Payment Agreement: Families will be invoiced monthly via their Teacher Ease account. Fees can be paid online via Teacher Ease using a credit card or can be paid by check. Fees should be paid by the first of each month for the following month. If fees are not paid in full by the 15th of each month for the following month, students will not be able to attend until fees are paid in full. If a check is returned due to insufficient funds, additional fees will apply.

Late Pick-up Policy:A fee of $1 per minute will be charged to your account for each minute after 6:00 p.m. that children are not picked up.

Policies & Procedures: All District 8 policies and procedures regarding student behavior and conduct will apply. By checking the box, you agree to access the school's handbook via the school website and abide by all school and district policies and procedures.

Consent to Emergency Treatment: I grant permission for the adult supervisors to obtain medical care from any licensed physician, hospital or medical clinic for the student(s) named herein at such time as either parent or guardian cannot be contacted in person or by phone. This authorization shall also include all activities, and we do hereby waive, release, absolve, indemnify, and agree to hold harmless activity sponsors, organizers, supervisors, and participants, for any claim arising out of injury to the student or accidents that may occur during the activity.

This program and facility are not licensed by or regulated by DCFS.

Required

Any additional information:

I understand that this registration is not complete until the $25 registration fee is paid. Parent/Guardian Signature: *

Submit

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