2022-23 Extended Learning Enrollment Form

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Thank you for your interest in enrolling your child into Model's Extended Learning Program! Please review the following information:

The Extended Learning program runs from Monday, August 29, 2022 - Friday, December 2, 2022 and Tuesday, January 17, 2023 - Friday, May 5, 2023.
Extended Learning tuition is $8/hour (for part-time attendance) or $65 per week (for full-time attendance). Additionally, there is an annual $50 enrollment fee charge per family. Tuition and fees are payable through the Infinite Campus Parent Portal.

Please complete one registration form for each child enrolling during the 2022-23 school year.

If you need to update this information at any time, please contact Extended Learning Coordinator Morgan Campbell (Morgan.Campbell@eku.edu).

Email *

First Name *

Last Name *

Grade *

During the 2022-23 School Year

Kindergaten

1st

2nd

3rd

4th

5th

6th

7th

8th

Parent/ Guardian First Name *

Parent/ Guardian Last Name *

Parent/ Guardian Cell Number *

Additional Cell/Work Number

Please indicate your preference for your student's enrollment in the Extended Learning program.
*

Full-time (flat rate of $65 per week ; available daily when school is in session until 6:00 p.m.)

Part-time (hourly rate of $8; based on hours attended)

Please list individuals approved to pick up your child, including: first and last name, relation to student, and individual's cell number. *

If you are the only individual who is approved to pick up your child, please list "Myself ONLY."

This agreement is made and entered into between Model Laboratory School, Eastern Kentucky University, and the signatory. I agree and understand that should I not pay the tuition and fees associated with the student account (all fees due 20th of each following month), the account will be subject to late fees($25 for each unpaid late payment), collection costs, and legal fees, if necessary to pursue collection. Additionally, I understand that the Extended Learning Program qualifies as an after-school program and tuition cannot be used for tax write-offs; therefore, no tax information is provided at the end of the year. *

A copy of your responses will be emailed to the address you provided.

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