2022-2023 Before School Registration

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PLEASE COMPLETE THIS REGISTRATION FORM & SIGN TO ENROLL YOUR CHILD IN THE BEFORE SCHOOL PROGRAM. PLEASE FILL OUT A FORM FOR EACH CHILD THAT IS ATTENDING.

PLEASE INCLUDE a $10.00 per family ENROLLMENT FEE WITH YOUR FIRST PAYMENT. Make checks out to BLUE CREEK SCHOOL, and note “Before School Program” in the memo field. Before school payments cannot be combined with lunch payments. Payment can be sent with your child on the first day of school.

Monthly payments are due before the month of use.

For example:
August payment-covers September
September payment-cover October
November payment-cover December

*$30.00 per month: 1 student
*$40.00 per month: 2 students
*$50.00 per month: 3 or more students

Invoices will be sent home on the 15th of the month in your students’ Wednesday folder. Payments are due by the 30th of the month and are applied to the next month. If an account becomes two months past due services will be discontinued.

HOURS OF OPERATION: THE BEFORE SCHOOL PROGRAM STARTS THURSDAY, AUGUST 25TH.

Before School:
Monday-Friday 7:00-7:40 am

*Child(ren) may not be dropped off before 7:00 a.m.
*Before school is unavailable on the weekends and school holidays

IF YOU HAVE ANY QUESTIONS OR CONCERNS FEEL FREE TO SEND AN E-MAIL TO NICOLE MENHOLT AT menholt@bluecreekschool.org OR CALL THE SCHOOL AT 406-259-0653.

Please list your child's name that will be involved in the before school program. *

Please provide your child's grade level. *

Please list his/her classroom teacher’s name. *

Please provide your current e-mail address. *

Please list your child allergies or food intolerance's.

Please describe/list any special needs or important information concerning your child.

Whom should we contact in case of an emergency? Please provide as much information as necessary. *

Are you interested in having your child participate in the breakfast program for an additional fee of $1.95/meal? **Note – there is no longer a snack provided to students attending before school *

Yes

IMPORTANT: Please read the agreement and provide your signature

• I understand that I am enrolling my child in Blue Creek School’s Extended Day Program for before school care.
• I hereby give permission for mutual exchange of information between the Blue Creek Extended Day Program, and the home regarding health and safety issues, attendance, food program status, special program enrollment and/or academic achievement.
• I understand that the before school program will be available on school days only, unless otherwise specified. I understand that the program is unavailable on weekends and school holidays.
• I understand that I am responsible to pay fees billed on the 15th of the month and these payments are due by the 30th of the same month to finance the next month.
• I understand that the before school program provides care before school from 7:00 a.m. to 7:40 a.m. and I understand that I am not to drop off my child(ren) before 7:00 a.m.
• I understand that my child(ren)’s continued enrollment is conditioned on the Blue Creek Extended Day Program being provided with current & working emergency contact names and phone numbers.
• I understand that film, print or digital images of my child(ren) and/or other students may be taken during program activities for program promotion, the school yearbook or weekly newsletters. I consent to such use and hereby waive rights to compensation. Any exceptions to this consent shall be provided to the school or the Extended Day Program Director in writing.
• In an emergency, I authorize the Blue Creek Extended Day Program staff and school employees to seek medical care for my child(ren).
• I understand that if my child(ren)’s inappropriate behavior during the before school program becomes intolerable, my child(ren) is/are subject to dismissal from the before school program.
• I, as the parent/guardian and my child(ren) are in receipt of, have read, and agree to follow all policies as stated in the Blue Creek Student Handbook.

Parent/Guardian Signature & Date *

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