2021-2022 Before School and/or Extended Day Program Registration Form

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You are completing the 2021-2022 Before School and Extended Day Program registration form.

***Please note, you are completing this registration form after the initial registration deadline for the enrollment lottery of 10:00 PM on June 28, 2021. Your registration will be accepted and your registration will be added to the end of our program waitlist in the order it was received following families who were waitlisted in the initial lottery for enrollment. You can expect to receive an update on your waitlist status within 5 school days.

Due to the length of our program waitlist and the challenging hiring climate at this time, we strongly encourage you to seek alternate care options for your student to ensure you have another plan for care for the school year.

Please see our 2021-2022 Before School and Extended Day Program informational Smore for full details https://www.smore.com/pv5gd.

Email *

What is your student's enrollment status? *

Returning Before School and/or Extended Day Student (You DO NOT pay a registration fee). *Please note we are not offering priority enrollment to returning students this year due to limited space and staffing.

Sibling of Returning Before School and/or Extended Day Student(s) ($100.00 non-refundable registration fee is due by July 30, 2021)

New Before School and/or Extended Day Student Sibling of Returning Before School and/or Extended Day Student(s) ($100.00 non-refundable registration fee is due by July 30, 2021)

Student's First Name: *

Student's Last Name: *

What Grade Is Your Student Entering in September 2021? *

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

What School Will Your Student Attend Beginning in September 2021? *

Cunniff Elementary School

Hosmer Elementary School

Lowell Elementary School

I am unsure what school my student will attend beginning in September 2021

Parent/Guardian #1 First Name *

Parent/Guardian #1 Last Name *

Parent/Guardian #1 Phone Number *

Parent/Guardian #1 Email Address *

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Parent/Guardian #2 Phone Number

Parent/Guardian #2 Email Address

Would you like to add an additional pick up person (other than the student's parent/guardians)? *

Yes

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