Preschool Extended Day Contract
Please indicate the hours you wish to contract each day. You may drop off
as early as 7:30 AM and your child may stay as late as 5:30 PM. Our staff will
ensure that your child is escorted to/from preschool at 8:05 AM and back at
12:10 PM on their preschool day.
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Student Last Name *
Student First Name *
Student's Grade *
My Child will attend Morning Care from 7:30-8am *
My child will attend Monday Afterschool Care.  The pickup time will be:
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My child will attend Tuesday Afterschool Care.  The pickup time will be:
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My child will attend Wednesday Afterschool Care.  The pickup time will be:
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My child will attend Thursday Afterschool Care.  The pickup time will be:
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My child will attend Friday Afterschool Care.  The pickup time will be:
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Parent Name *
Parent Phone Number *
Parent Name
Parent Phone Number
Authorized Pickup Other Than Parent *
Phone Number for Authorized Pickup Other Than Parent *
Authorized Pickup Other Than Parent
Phone Number for Authorized Pickup Other Than Parent
Does your child have any allergies? *
If you said yes above, please describe the allergy and the protocol for care.
I give my approval for my FACTS Account to be charged.  I understand that I will be responsible for payment of the above hours of care requested, regardless of whether my child is in attendance on that given day.  Please type parents full name below to indicate your approval of these charges *
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