K-8 Extended Care Enrollment Contract

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2021-2022 School Year

Parent 1 Name & Phone *

Parent 2 Name & Phone

Child 1 Name and Grade (K-8 Only) *

Child 2 Name and Grade (K-8 Only)

Child 3 Name and Grade (K-8 Only)

I am requesting Extended Care: (Please mark all the apply) *

Before School Monday (any time between 7am-8:20am)

Before School Tuesday (any time between 7am-8:20am)

Before School Wednesday (any time between 7am-8:20am)

Before School Thursday (any time between 7am-8:20am)

Before School Friday (any time between 7am-8:20am)

After School Monday (any time 3-6pm)

After School Tuesday (any time 3-6pm)

After School Wednesday (any time 2-6pm)

After School Thursday (any time 3-6pm)

After School Friday (any time 3-6pm)

Required

You will be charged for the number of hours your child is present in Extended Care, versus the number of days. The combined hours of care we need per week, per child will be: *

1-7 hours/week: $175 per month

8-14 hours/week: $275 per month

15-27 hours/week: $350 per month

I will purchase a punch card in 10 hour increments as we will not need care more than one session per week.

I agree to have the monthly fee or the fee for a punch card added to my FACTS account on the 1st day of every month from September 2021-June 2022. These charges will be listed in my FACTS account as an 'Incidental Billing". Please type "Yes, I agree". *

Signature: Please type your full name below confirming that you agree to enrollment in the Extended Care program at Christ the King School for the 2021-2022 School Year. If your plans change, please notify us a minimum of 30 days in advance to avoid a charge for the following month. *

Date of Signature *

YYYY

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