After-School Care Program - Registration Contract Form - 2023-2024
Please fill out the information below if you wish to have your child(ren) participate in Vysehrad ISD's After School Care Program for the 2023-2024 school year.

Fees for Service:  $10 per day (Fees will be accumalated for the month.  At the end of the each month, parents will receive a payment invoice with amount of total fees for the month.  Cash and checks are accepted.  Fees apply to entire day of service no matter if child(ren) are picked up early.

Days of Service:  Mondays, Tuesdays, Wednesdays and Thursdays (following the school calendar excluding any holidays school is not in session).

Times of Service: 3:30 PM to 5:15 PM

Expectations  
Discipline:  Every child attending the program will be expected to follow school rules and expectations as they would during regular school hours.  Any child who does not follow the rules may be removed from the program at any given time.
Tardiness:  Students are expected to be picked up by 5:15 PM each day if not sooner.  Any child not picked up in a timely manner, may be removed from the program at any given time.  

Please call the school office if you have any questions.  (361) 798-4118


Email *
Date: *
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Child 1 Information:  
Name of Child requesting to attend After-School Care Program (Please list information as follows:  Child's first name, last name, grade level and any allergies to foods/insects, etc.):
 *
Child 2 Information:      
Name of Child requesting to attend After-School Care Program (Please list information as follows:  Child's first name, last name, grade level and any allergies to foods/insects, etc.):
Child 3 Information:     
Name of Child requesting to attend After-School Care Program (Please list information as follows:  Child's first name, last name, grade level and any allergies to foods/insects, etc.):
Child 4 Information:     
Name of Child requesting to attend After-School Care Program (Please list information as follows:  Child's first name, last name, grade level and any allergies to foods/insects, etc.):
Parent/Guardian Contact Information #1:
Parent's/Guardian's Name and Contact Information (Please list information as follows: Parent/Guardian's Name, Relationship to child and then Phone Number following):
 *
Parent/Guardian Contact Information #2:
Parent's/Guardian's Name and Contact Information (Please list information as follows: Parent/Guardian's Name, Relationship to child and then Phone Number following):
 *
Emergency Contact Information #1:
Emergency Contact Information (Please list information as follows: Person's Name, Relationship to child and then Phone Number following):
 *
Emergency Contact Information #2:
Emergency Contact Information (Please list information as follows: Person's Name, Relationship to child and then Phone Number following):
 *
Allowable Pick-Up List:  
(Please list the individuals who you give permission to pick up your child if it is anyone other than you, the parent/guardian.  Anyone not on this list will not be allowed to pick up your child.)
 *
Grade of Child(ren) attending program: *
Required
My child(ren) plans to attend the program: *
Required
My child is allergic to the following: *
Agreement Statements:
Please check all boxes if you agree to the guidelines of Vysehrad ISD's After-School Care Program.
 *
Required
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