Extended Day Application - 2021-2022 School Year
Thank you for your interest in the DCSS Extended Day Program! Please read the information below carefully to make sure you don't miss any important information.

Still being cautious about COVID-19, we will have smaller groups than in a typical year. Slots are available on a first-come, first-served basis. You will be notified if you have been accepted or if you've been placed on a waiting list.

We plan to be open every school day, closing at 5:45 pm, for any DCSS student, Pre-K – 8th grade. Not every school has an Ext. Day site, but students can be shuttled by DCSS bus to school with one. Parents MUST submit a “Student Transportation Request Form” to the DCSS Transportation Dept. (see DCSS website).  

Extended Day services are currently offered at the following school-based sites NOTE: These schools will provide services to students shuttled in from the other schools indicated:

- International Studies Elementary Charter School- Morningside, Radium Springs Elementary, Robert Harvey, Turner, Albany Middle School and Radium Springs Middle School.
- Lake Park Elementary School
- Lincoln Elementary Magnet School
- Live Oak Elementary School - Robert Cross Middle Magnet School
- Dougherty County Pre-K at the Magnolia Early Childhood Education Center
- Sherwood Acres Elementary School - Northside, Merry Acres Middle
- West Town Elementary School - Alice Coachman, MLK Elementary, Lamar Reese Elementary

Please call the Extended Day Office at 229-431-1280 if you have any questions.

All Extended Day students must meet basic standards in areas of self-care, communication, mobility, social-emotional development, and behavior.

Extended Day students get support from the Georgia Department of Family and Children's Services Childcare and Parents Services (CAPS), and United Way. The vast majority of funding is from tuition, but we try to help families with unusual circumstances.

If YOU BELIEVE YOU MAY BE ELIGIBLE FOR REDUCED RATES, please go to http://gateway.ga.gov and click "Apply for Benefits" on the lower right side or call 1- 877-423-4746 between 9:00AM-5:00PM. NOTE: there may  be other special rates in rare circumstances. BUT YOU MUST apply with CAPS first, http://gateway.ga.gov.

Please note that there is no “Before 4:00 Plan” this year. All students must be picked up by 5:45 p.m. or be assessed a late fee.

Lastly, once you complete this application you'll be provided with a link to make your payment online via the My School Bucks App. - NOTE - Please pay as a 'Guest' when you pay online. Please know that the link to pay your Extended Day fees is also available at www.docoschools.org/extendedday.

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Email *
Payments:
Parents can pay for services weekly or monthly. If paying weekly, payment is due each Monday. Payments are due the first day the student attends. Students may incur a late fee if not picked by 5:45 p.m.
Additional Information:
- Students are provided a healthy snack daily.

- Students who fail to meet behavior standards will be provided with a write-up. Students with three write-ups are subject to dismissal from the program.

- Pick up: Come to the school entrance door where you'll be greeted by a staff member. Please sign out your student and help us facilitate social distancing and student safety by ensuring you stay six feet apart from staff members and other students. Also, masks are required when on school property.

- Please make payments online

Student's School That They Attend During the Day: *
Grade: *
Teacher:
Student's Name: *
Student's Date of Birth *
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YYYY
Student's Age: *
Student's Address: (Street number, Street Name, City and State). *
Student's Zip Code: *
Mother's Name:
Mother's Cell Phone:
Mother's Home Phone:
Mother's Work Phone:
Mother's Employer:
Father's Name:
Father's Cell Phone:
Father's Home Phone:
Father's Work Phone Number:
Father's Employer:
Emergency Contact 1 Name: *
Emergency Contact 1 Phone Number *
Emergency Contact 1 Relationship to Student: *
Emergency Contact 2 Name: *
Emergency Contact 2 Phone Number: *
Emergency Contact 2 Relationship to Student: *
Emergency Contact 3 Name:
Emergency Contact 3 Phone Number:
Emergency Contact 3 Relationship to Student:
Only the following People have permission to pick up my child:
No one other than the parents, the emergency contacts and the people below have the ability to pick up a student.
Name #1:
Phone Number (If not listed above)
Name #2:
Phone Number (If not listed above)
Name #3:
Phone Number (If Not Listed Above):
Name #4:
Phone Number (If Not Listed Above)
Student's Medications, Allergies, and Limitations Requiring Special Attention:
Acknowledgement and Signature:
By checking the box below and writing your full legal name, you agree that you've read all sections of this form. Due to COVID-19, I understand it is the plan of Extended Day to follow the intent of the Dougherty County School System, to keep students and staff safe and healthy. All staff and students will be kept six feet apart and wear masks. Hand-washing or sanitizing will be done frequently. I give permission for my child’s photo to be used for publicity, and/or by the media. I give permission for my child to participate in all Extended Day activities, unless I tell the Site Coordinator beforehand, and I understand proper supervision and safety will be upheld.

This school year I understand no trips are planned. Sharing of items will not be permitted. Use of personal and school devices is limited to educational use only.
Having read all sections of this form: *
Required
Full Legal Name: *
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