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Extended Day Registration (PGC) 2022-2023
Please complete the Extended Day registration form for the 2022-2023 school year. You will need to complete a separate form to sign up for the days in which you will need to use the program. For staffing purposes we ask that you notify us at least 24 hours in advance that you will be using the service. Extended Day is ONLY available at the PGC for the 2022-2023 School Year.
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* Indicates required question
Email
*
Your email
Family Last Name
*
Your answer
Student #1 Name
*
(Last Name, First Name)
Your answer
Student #1 Grade
*
Choose
Preschool
Kindergarten
1st
2nd
3rd
Student #1 Allergies
If your child has any allergies, health concerns, or other important information, please provide a short explanation.
Your answer
Student #2 Name
(Last Name, First Name) If none, just leave blank
Your answer
Student #2 Grade
Choose
Preschool
Kindergarten
1st
2nd
3rd
Student #2 Allergies
If your child has any allergies, health concerns, or other important information, please provide a short explanation.
Your answer
Student #3 Name
(Last Name, First Name) If none, leave blank
Your answer
Student #3 Grade
Choose
Preschool
Kindergarten
1st
2nd
3rd
Student #3 Allergies
If your child has any allergies, health concerns, or other important information, please provide a short explanation.
Your answer
Will your child be attending AM, PM or Both?
AM only
PM only
AM & PM
Clear selection
Parent Name
*
Your answer
Parent Address
*
Your answer
Parent Phone Number
*
Your answer
Emergency Contact #1
*
Please list the name, phone number (mobile preferable), email and relationship of the FIRST person that should be contacted in case of an emergency.
Your answer
Emergency Contact #2
*
Please list the name, phone number (mobile preferable), email and relationship of the FIRST person that should be contacted in case of an emergency.
Your answer
Emergency Contact #3
*
Please list the name, phone number (mobile preferable), email and relationship of the FIRST person that should be contacted in case of an emergency.
Your answer
Additional People Authorized to pick up
*
Please list name, relation to child, and a phone number (mobile preferable).
Your answer
I understand that in order to use the Extended Care services at anytime during the 2022-2023 school I will need to pay a $50 (per family) annual fee.
*
Fee will be applied to your FACTS account
Yes, I understand.
I understand that if my child is in 1st-3rd grade they will automatically go to the homework area for 1 hour. This area will be supervised by an Extended Day staff member. The cost is a flat fee of $15/student for Morning Extended Day and a flat fee of $25/student for Afternoon Extended Day.
*
Yes, I understand.
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