JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Washington Irving Before & After Care Program 2022-2023 Application
Washington Irving Elementary School
18101 N Western Ave
Edmond, OK 73012
Nancy Priddy, Co-Director
LaDonna Crampton, Co-Director
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Child #1 - Name
*
Your answer
Child #1 - Grade for 2022-2023
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Child #1 - Date of Birth
*
MM
/
DD
/
YYYY
Child #2 - Name
Your answer
Child #2 - Grade for 2022-2023
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Clear selection
Child #2 - Date of Birth
MM
/
DD
/
YYYY
Child #3 - Name
Your answer
Child #3 - Grade for 2022-2023
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Clear selection
Child #3 - Date of Birth
MM
/
DD
/
YYYY
Parent/Guardian #1 Name
*
Your answer
Parent/Guardian #1 Work phone
*
Your answer
Parent/Guardian #1 Cell phone
*
Your answer
Parent/Guardian #1 Email address
*
Your answer
Parent/Guardian #2 Name
Your answer
Parent/Guardian #2 Work phone
Your answer
Parent/Guardian #2 Cell phone
Your answer
Parent/Guardian #2 Email address
Your answer
My Child will attend the program during the following days and times:
*
Before Only (7:15-8:20)
After Only (3:45 - 5:40)
Before AND After (7:15-8:20; 3:45-5:40)
Not attend the program on this day
Monday
Tuesday
Wednesday
Thursday
Friday
Before Only (7:15-8:20)
After Only (3:45 - 5:40)
Before AND After (7:15-8:20; 3:45-5:40)
Not attend the program on this day
Monday
Tuesday
Wednesday
Thursday
Friday
Please type your initials below the following statements regarding our program and its procedures.
Attendance: I am aware that I am required to sign up for a certain amount of days for the week. The number of days and/or the particular days that my child signs up for MAY NOT vary from week to week. I must commit to paying for all of the days that I sign up for, regardless of whether my child attends or not. I will not be charged for school wide holidays or snow days.
*
Your answer
Withdrawing from the program: I am aware that if I withdraw my child from the Before and After Care Program without notifying the Director, and not giving a 2 week notice, my child WILL NOT be readmitted for the remainder of the school year.
*
Your answer
Program Hours: I am aware that the After Care Program closes at 5:40 pm. If I repeatedly arrive after 5:40 pm, (more than 3 occurrences), I will incur a late fee of $1.00 per minute and the 5 minute courtesy will be waived for the remainder of the school year.
*
Your answer
Payment: I am aware that payment is due at the first of the month regardless of what day my child attends. I also understand that if payment is not received by close of after care on the 15th, I will be charged a late payment fee of $15, in addition to my program fees.
*
Your answer
The purpose of our procedures and policies is to be helpful and usable, and to strengthen our partnership with you. Please type your name and today's date, stating that you have read and agree to the condition of our procedures and policies.
*
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Edmond Public Schools.
Report Abuse
Forms