Extended Care Reservation Form

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Please complete if your child is planning to use Extended Care. Please note: Extended Care will be held in the 6th grade classrooms. Extended Care will end at 5:00 p.m. daily. Please pack a dry snack and water only for your child. Students may bring personal items/toys in a plastic shoe box with a lid clearly labeled with their name. Thank you. Mrs. Bozzi - class2b@stjaneschool.com or Ms. Johnstone kindergarten2@stjaneschool.com

NOTE: The format has changed. You must enter the date of when you will be using Extended Care. This is eliminate a new form being created each week.

Family Last Name *

First Name (of all your children attending) *

Grade (s) *

Monday *

YYYY

Tuesday

YYYY

Wednesday

YYYY

Thursday

YYYY

Friday

YYYY

Because of the location of Extended Care this year, we will dismiss on the 1/2 hour. If you are running late, please come at the next 1/2 hour interval. Thank you. I plan to pick up my child at the following time *

3:00 p.m.

3:30 p.m.

4:00 p.m.

4:30 p.m.

5:00 p.m.

Emergency Contact with phone number please -- someone who can pick up child immediately if necessary. *

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