CCS Afterschool Care Registration 23-24
Please fill out the information below to register your child for Afterschool Care for the 2023-2024 school year.  There is a $30.00 registration fee/family that will be debited from your FACTS account on the 20th of September. All ASC fees will be debited from your FACTS account on the 20th of each month.  
Contact Dr. Smith for questions,  ssmith@ccscatholic.com
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Family Last Name *
Primary Email Address *
Student #1 Name *
Student #1 Grade *
Student #2 Name
Student #2 Grade
Student #3 Name
Student #3 Grade
Parent Name #1 *
Parent Phone #1 *
Parent Name #2
Parent Phone #2 
Emergency Contact Name *
Emergency Contact Phone *
People who may pick up my child/children other than those listed above (3 maximum)
Anyone NOT permitted to pick up my child/children
Allergies and/or helpful information
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