Fall Break 2023 Waiting List
This form is for Fall Break Care only.
-If you are already enrolled in our program please do not fill this out. Please contact your site director for information if you are already enrolled.
-If a spot becomes available we will contact you to let you know that your child may attend Fall Break Care. We will also give you information on what to do next.  
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Email *
What is your name? *
What is your phone number? *
Does this child attend SAC currently?  *
Has this child attended SAC in the past? *
What is the child's name?  (First and Last) *
What is the child's birthday? *
MM
/
DD
/
YYYY
What grade is this child currently in? *
What days/ weeks will this child need? *
Required
Parent Authorizations *
Required
Does your child have any know allergies? *
Do you need staff to administer any regular medication? *
What school does this child attend? *
I authorize the child care personnel to arrange emergency medical care for my child in the event that I can not be reached. *
Do you have another child to add? *
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