Before and After Care

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Before and After Care Signup and Registration 2023-2024

This form must be filled out the first time the before & after care program is used each year and any time there is a change in the emergency contact information. Note: Your child will NOT be released to anyone not listed on this form. Identification (i.e. Driver's License or another form of photo ID) will be required to be shown unless the adult's identity is known to staff

Please complete one form per child enrolled.

Child's Frist Name *

Child's Last Name *

Child's Middle Initial

Does the Child have any Allergies? *

If yes, please list allergies

Grade for 2022-2023 School Year *

Care Needed *

Before Care Only (Full-Time 3 or more days)

After Care Only (Full-Time 3 or more days)

Before and After Care (Full-Time 3 or more days)

Before Care Only (Part-Time 3 or less days)

After Care Only (Part-Time 3 or less days)

Before and After Care (Part-Time 3 or less days)

Days Needed *

Parent / Guardian Information #1

First and Last Name

Parent / Guardian Information #1

Phone Number

Parent / Guardian Information #2

First and Last Name

Parent / Guardian Information #2

Phone Number

Emergency contact Information #1

First and Last Name

Emergency contact Information #1

Phone Number

Emergency contact Information #2

First and Last Name

Emergency contact Information #2

Phone Number

Please list Name and Phone number of any authorized parties to release your child to: *

Consent to Treat:

In case of emergency, St. Albert the Great Academy staff is authorized to call 911 and transport my child to the nearest emergency medical facility. Emergency contacts will be notified as soon as possible. In the event of an anaphylactic reaction, school staff is authorized to administer the child's personal epipen.

Please add Legal Guardian First and Last Name Below

Additional Information

Financial Agreement:

By electronically signing this form, I agree to pay St. Albert the Great Academy the below rates for before & after care. My FACTS account will be billed monthly for the care received. Should I signup for before or after care and chose to pick up my child early or not use the care services on that day, I understand I will be billed for the service as St. Albert's has staffed based on my request. I will not be billed for days that I do not signup for before & after care. If my before & after care bill is left unpaid for 30 or more days, my child(ren) will be unable to use the St. Albert's before and after care program until the bill is rectified or special arrangements have been made. If the bill is 60 or more days delinquent, my child(ren) may be subject to dismissal from St. Albert the Great Academy until the bill is rectified or special arrangements have been made.

Please add Legal Guardian First and Last Name Below

St. Albert's Before & After Care Program is open on school days when school is in session. Before & After Care will not be available on holidays, snow days or any day when school is not in session. If St. Albert's is in session with an early dismissal, Before care will be available prior to the school day, but After Care will not take place after early dismissal. If St. Albert's is delayed (due to inclement weather or otherwise), Before care will not be available, but After Care will take place. By typing my name below I agree to these and all terms of Before and After care and I will complete a new form yearly for my child. By Adding my name below I agree to these and all terms of Before and After Care, *

Behavior Agreement:

I understand that St. Albert's Before & After Care Program is a privilege for my children to attend. My children will be expected to show respect to staff and peers. Behavior problems will not be tolerated. Scheduled programing will take place (i.e. homework, active time, snack time) and all students are expected to participate. Snacks cannot be provided by St. Albert's and must be sent in from home.

By Adding your name below you confirm that you have discussed these terms with your child and are in agreeance.

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