* If cancelling your Extended Care plan, please note that the Extended Care program can be used on an "as needed" basis for a fee of $9.70 per hour.
Early Morning Care
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Afternoon Care
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Nap Option (Pre-Kindergarten Only)
All Full-Day Pre-Kindergarten students must choose a nap option. All Full-Day Preschool students are required to take a nap.
A fee of $16.50 will be added to your bill for a nap cot sheet.
Nap Options
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Extended Care Change Requests
Please select the start date for any changes you are requesting above.
Start Date *
MM
/
DD
/
YYYY
Pick-Up Permission
The following individual(s) may pick up my child(ren) from Extended Care.
Name of First Individual (First and Last Name)
Your answer
Name of Second Individual (First and Last Name)
Your answer
Non-Medical Information
Parents are responsible for providing food substitutions for lunch, snacks, etc.
Dietary Restrictions
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Parental/Guardian Approval
By typing your name on the line below, you are acknowledging that you are the parent/guardian of the above named student and approve the information provided on this form.
Parent/Guardian's First and Last Name *
Your answer
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