JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2023-2024 Extended Care Enrollment Form
Every family needs to complete this form, whether or not you anticipate using Before or After Care during the school year.
Pricing will be announced shortly
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
STUDENT INFORMATION:
*
CHILD NAME #1:
Your answer
CHILD #1 DOB:
*
MM
/
DD
/
YYYY
CHILD #1 GRADE IN 2023-2024:
*
TASTE OF PRESCHOOL
PRE-SCHOOL 3
PRE-SCHOOL 4
KINDERGARTEN
1ST GRADE
2ND GRADE
CHILD #1 ALLERGIES & MEDICAL CONDITIONS (N/A if none):
*
Your answer
CHILD #1 ETHNICITY
Your answer
Next
Page 1 of 4
Clear form
Never submit passwords through Google Forms.
This form was created inside of Evangelical Lutheran Church Saint Luke Chicago.
Report Abuse
Forms
