Hugo Campus Extended Day Contract
2023-2024
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Student Last Name *
Student First Name *
Before Care begins at 7:30 am and is for any child dropped off before 8:05 am.  My child will attend Before Care on:
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Student Grade
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My child will attend Monday Afterschool Care.  The pickup time will be:
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My child will attend Tuesday Afterschool Care.  The pickup time will be:
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My child will attend Wednesday Afterschool Care.  The pickup time will be:
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My child will attend Thursday Afterschool Care.  The pickup time will be:
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My child will attend Friday Afterschool Care.  The pickup time will be:
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Parent Name *
Parent Phone Number *
Parent Name
Parent Phone Number
Authorized Pickup Other Than Parent *
Phone Number for Authorized Pickup Other Than Parent *
Authorized Pickup Other Than Parent
Phone Number for Authorized Pickup Other Than Parent
Does your child have any allergies? *
If you said yes above, please describe the allergy and the protocol for care.
I give my approval for my FACTS Account to be charged.  Please type parents full name below to indicate your approval of these charges *
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