2021-2022 UCS School Age Childcare Pre-registration
• Completing the online form is not a confirmation of registration.
• Once families complete the form, a SACC representative will contact you to confirm registration and process your payment. Please have your credit card information prepared.
• If registration is full, you will receive an email to be placed on the wait list.
• Once payment is complete, you will receive a separate email with required paperwork.
• Completed paperwork must be emailed to sacc@uticak12.org before child attends care.

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I understand that by completing this form I am "pre-registering" my child. I have read the information provided on the website including pricing and schedules.  I also understand that my child is not registered until the SACC offices calls and payment is completed over the phone.   If spots are full, I understand I will receive an email only. *
Primary Payer Name (Last Name, First Name) *
Primary Payer Address (Street, City, State, Zip Code) *
E-mail address *
Primary Payer Phone Number *
Have any of your students attended SACC in the past (summer or fall)? *
What school does your student attend throughout the school year? *
Will your child attend in the morning (AM), afternoon (PM) or both? *
How many days a week will your student(s) be attending?  Please note: Students are required to attend a minimum of 2 days a week.   *
Student #1 Name (Last Name, First Name) *
Student #1 Grade *
Student #2 Name (Last Name, First Name)
Student #2 Grade
Student #3 Name (Last Name, First Name)
Student #3 Grade
Will your student require medicine to be administered on site? *
If yes, please explain below. District paperwork is required to be on file and signed by a physician. Please note: We are no longer allowed to administer Nebulizer treatments.
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