Oak Grove Cares Registration Form
We are excited to provide the Before and After Care Program at Oak Grove School! We look forward to working with you and providing you with a low cost service for your needs.
Email *
Student #1 First & Last Name *
Student #1 Birthdate *
MM
/
DD
/
YYYY
Student #1 Current Grade *
Student #2 First & Last Name (if applicable if not move to the next section)
Student #2 Birthdate
MM
/
DD
/
YYYY
Student #2 Current Grade
Parent(s) / Guardian Information
As the individual completing this form, you are an authorized person to pick up the above students in the event of a family emergency, routine or early pick-up, or unexpected closure of the Oak Grove facility.  Unless otherwise stated on this form or the completion of an authorized pick-up form throughout the year, no unauthorized individual shall be allowed to pick up the above registered student(s). (Photo ID's may be required at time of pick-up)
#1 Parent / Guardian First and Last Name *
#2 Parent / Guardian First and Last Name (if not applicable just enter N/A) *
Student(s) - #1 Parent Guardian Physical Address (City and Zip only if different  from Bartonville, IL 61607) *
#2 Parent / Guardian Physical Address (if split household or joint custody, if same state "same" or N/A if this does not apply)
Contact Information & Order of Contact
In the event that the Oak Grove Cares Coordinator or Assistant need to get ahold of you for an emergency situation or illness, the order of calling will be #1 Parent / Guardian cell phone (1), home phone (2 - only if provided or different than cell), and finally work phone (3).  Every effort will be made to contact the parent / guardian who is completing this form first. #2 Parent / Guardian cell phone (1) and finally work phone (2) will be called if #1 parent is not reached if applicable.  If contact cannot be made with Parent 1 or 2, emergency contacts will be notified according to priority of contact listed on this form.
#1 Parent / Guardian Cell Phone *
#2 Parent / Guardian Cell Phone
#1 Parent / Guardian Home Phone (2) (if applicable)
#2 Parent / Guardian Home Phone (2) (if applicable)
#1 Parent / Guardian Work Phone (3) *
#2 Parent / Guardian Work Phone (3)
#1 Parent / Guardian Email Address *
#2 Parent / Guardian Email Address
Number of Days & Type of Days
Indicate below the number of days the registered students will attend and if they will attend before care only, after care only, or both before & after care.  As you can imagine, schedules can be very complex so it is very important to communicate schedules with the OG Coordinator as soon as possible and when things may change throughout the year.
Which days of the week will student(s) attend? *
Required
When will the student(s) attend on the days specified above? *
Required
Date of first attendance? *
MM
/
DD
/
YYYY
Do you anticipate utilizing this service for the entire school year? *
Do you anticipate utilizing SIP day services for the additional fee for those days? *
Do you anticipate utilizing Teacher Institute day services for the flat daily fee for those days? *
Do you anticipate utilizing the lunch service on School Improvement Days or Teacher Institute Days? *
I have registered at Oak Grove School and authorize the viewing and use of my student(s) medical and registration information provided for the before and after care program by the OG Cares Coordinator, Assistant, and substitute care givers. *
Emergency Contact and Authorization for Student(s) Pickup
By providing additional emergency contacts, I authorize and approve the following individuals to pick up my child from the after care program at Oak Grove School.  I additionally understand that the OG Cares Coordinator and Assistant may ask for photo identification of any emergency contact that is unfamiliar to them.
Emergency Contact #1 First and Last Name
Emergency Contact #1 Cell Phone *
Additional Emergency Contact #1 Number
Emergency Contact #2 First and Last Name
Emergency Contact #2 Cell Phone *
Additional Emergency Contact #2 Number
Additional Contacts
If you have additional contacts, please complete an additional contacts form as provided by the Oak Grove Cares Coordinator.
If you do not plan to apply for a reduced rate please let us know here. *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Oak Grove SD #68. Report Abuse
Google Forms