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Pre-K Early Care and After Care Registration Form
2023-2024 School Year
School Safety Guidelines will be followed.
Additional charges will be assessed if your child is not picked up by 6:00 p.m.
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* Indicates required question
Email
*
Your email
Student's Name (last, first)
*
Your answer
Class:
*
PreK 3-2FB (2 Full Days)
PreK 3-3FB (3 Full Days)
PreK 3- 5F (5 Full Days)
PreK 4-3F (3 Full Days)
PreK 4-5F (5 Full Days)
PreK 4-5FB (5 Full Days)
K-1
K-2
1-1
1-2
2-1
2-2
3-1
3-2
4-1
4-2
5-1
5-2
6-1
6-2
7-1
7-2
8-1
8-2
Other (please select if unsure of student's class)
Required
Address:
*
Your answer
Home Phone:
*
Your answer
Cell Phone:
*
Your answer
Emergency Contact 1: (name, telephone, relationship)
*
Your answer
Emergency Contact 2: (name, telephone, relationship)
*
Your answer
Is there any person who MAY NOT HAVE ACCESS to your child?
*
Your answer
Early Care
Drop Off (
PRE-K ONLY
) 7:15-7:45
*
$ 5 Per Day Billing
$ 300 Billing for the School Year (use as often as needed)
n/a
After Care
Billing Schedule (can only be changed with written notification to school office prior to end of month billing cycle):
*
2 to 3 Day Program ($ 110 per month - $40 each additional child)
4 to 5 Day Program ($ 220 per month - $ 40 each additional child)
Daily (no set schedule, days may vary) ($ 12 per hour per child)
n/a
Required
Which days will you use early care or after care?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Days will vary
Required
Does your child have an allergy?
*
Yes
No
Required
If yes, please indicate allergies.
*
Your answer
Does your child's allergy require an Epi Pen to be administered?
*
Yes
No
N/A
Required
Will you be supplying After Care with an EpiPen?(separate from the one provided for the normal school day)
*
Yes
No
N/A
Required
Are there any specific medical conditions or issues of concern?
*
Yes
No
Required
Please explain briefly the medical condition or issue of concern.
Your answer
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