XLT JTSD 5th Quarter Care 2020

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

General Information

XLT JTSD 5th Quarter Care has limited space due to the state guidelines and general safety of our program. Completing this form does not guarantee your child has a spot in XLT JTSD 5th Quarter Care. Once you complete this form an XLT Supervisor will contact each family via email if you have a space in XLT JTSD 5th Quarter Care. Then you will be directed to pay via Schoolpay to hold your spot at XLT JTSD 5th Quarter Care.

Ages: JTSD Kindergarten to 6th grade. The grade your student is in as of the 2019-20 School Year which is this current school year.

Locations: JTSD XLT will be held in the JTSD FEMA Shelter.

Schedule Options: Only Full time care for the 2 weeks of JTSD 5th Quarter on June 8th-June 19th, 2020. We will provide AM only, PM only, and AM & PM care options.

Hours of Operation: XLT will provide care from 6:30am until school starts and after school until 6:30pm. If your child attends JTSD they will not be allowed to be transported to their home school for XLT. They will have to attend JTSD XLT for the two weeks.

Non XLT Students: Students who were not enrolled in XLT or Eagle Care for the 2019-2020 school year will need to complete the XLT enrollment form here: https://forms.gle/BZXrmYZka3uJAvBT7

in addition to this summer school registration form, there is a $25.00 family registration fee applied to non XLT students who register for XLT Summer School Care.

REGISTRATION ENDS MAY 22ND!

Fees

Tuition Fee (covers all 2 weeks, This is a prorated rate already so we will not be giving discounts or prorating for any days not attended):

AM ONLY=$67.50

PM ONLY=$112.50

AM & PM=$150.00

No Discounts will be available due to the adjusted rate already given above.

***XLT has limited space. The completion of this form does not mean you have a spot in XLT JTSD 5th Quarter Care.***

Registration and Payment

Registration takes 1 business day to process after submission.

Payment in full is due once you have been contacted by an XLT Supervisor that you have a spot.

Online payments can be made at www.schoolpay.com

Payments can be made by check, cash, and money order at the XLT office.

Please contact the XLT office at 724-6190 or email tonyawilloughby@nixaschools.net with any questions.

Limited Space Policy *

I have read and agree to the above policy

Required

Cancellation Policy *

If you must cancel, you must do so prior to May 22nd, 2020. Any schedule changes or drops after MAy 22nd may not be accommodated or refunded due to staffing, limited space, and prepayment for supplies and activity costs. All schedule/drop requests must be made in writing or emailed to tonyawilloughby@nixaschools.net

I have read and agree to the above policy

Required

CHILD FIRST NAME *

CHILD LAST NAME *

CHILD DATE OF BIRTH *

MM/DD/YYYY

IS YOUR CHILD CURRENTLY ENROLLED IN XLT? *

YES

CHILD GRADE *

Select the grade your child is currently in at JTSD as of the 2019-20 School Year.

CHILD ADDRESS *

PARENT/GUARDIAN FULL NAME (S) *

please enter one or both parent names

PARENT/GUARDIAN CONTACT PHONE *

XXX-XXX-XXXX

PARENT/GUARDIAN 2ND CONTACT PHONE

XXX-XXX-XXXX

FIRST EMERGENCY CONTACT NAME *

other than parent

FIRST EMERGENCY CONTACT PHONE *

xxx-xxx-xxxx

SECOND EMERGENCY CONTACT NAME

other than parent

SECOND EMERGENCY CONTACT PHONE

xxx-xxx-xxxx

Authorized Pick Up #1 *

Authorized Pick Up #2 *

Authorized Pick Up #3 *

SCHEDULE *

JUNE 8TH, 2020-JUNE 19, 2020

AM ONLY $67.50

PM ONLY $112.50

AM & PM $150.00

Required

Accommodations *

Are any special accommodations due to a disability needed to participate?

Yes

Explain

If Yes, please explain. Also List allergies below.

Signature *

Please type your full name and last 4 digits of your social security number. This will denote your signature and confirm submission of this registration form. By signing this form you agree that your are a responsible party for this child and have read and understand the policies and procedures set forth by the Missouri Department of Health and Senior Services for licensed childcare centers and by Nixa Public Schools XLT program.

Questions or Comments

Please enter any questions or comments below.

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Nixa Public Schools. Report Abuse

Forms