Extended Care Registration Form

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2023-2024 School Year

Email *

Student Name *

Parent/Guardian Name *

Parent/Guardian Phone Number *

Day(s) of Care Needed *

Monday (2:30 - 4:00pm) Cost $5.00

Tuesday(2:30 - 4:00pm) Cost $5.00

Wednesday(12:00 - 4:00pm) Cost $10.00

Thursday(2:30 - 4:00pm) Cost $5.00

Friday(2:30 - 4:00pm) Cost $5.00

As Needed (Cost $5.00 on Regular days and $10.00 on Early Release days)

Required

Additional Pick-Up Contact(s)

Special Notes (if applicable)

Extended Care Terms *

Please click the box to acknowledge the Extended Care terms.

Expectations are the same as being in the classroom.

If your student has behavior issues while attending extended care, they will be given a warning. If behavior issues continue, they will not be allowed to attend extended care until a meeting with the parent, student and extended care staff is completed.

I understand the cost of extended care is: Regular Days $5.00 per day from 2:30pm - 4:00pm - Early Release Days $10.00 per day from 12:00pm - 4:00pm

I understand that extended care is only available until 4:00pm.

The school will send a monthy statement by email. Payment can be made to Edison School by check, cash or our online payment portal.

If you are more than 30 days behind on payment, your student will not be allowed to attend until the balance is paid in full.

Required

Electronic Signature Agreement *

By signing below, I agree to the terms of extended care listed above.

"I certify that I am signing this Form electronically. I agree that my electronic signature is the legal equivalent of my manual signature on this Form.”

Required

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

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