Kids Club Registration 2023-24 School Year
Pilgrim Lutheran Christian School Before and After School Program

*Please fill out one form per child.
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Student Name *
Student's Class *
Days and Times (choose all that apply)
Charge is $8 per hour for Preschool students; $7.50 per hour for students in K - 4th Grade  *
7 - 8 am
3 - 4 pm
4 - 5 pm
5 - 6 pm
Not attending
Monday
Tuesday
Wednesday
Thursday
Friday
Approximate arrival time (before school) and/or pick up time (after school) *
Family/Person to be billed via FACTS
Billing occurs on the 25th of the previous month and is due by the 10th of the month. Because you are billed for the school days in each month, billing may vary by month.
 *
Date schedule will begin. *
MM
/
DD
/
YYYY
I have verified that my child's information is current on the FACTS SIS ParentsWeb system, including authorized and unauthorized pick-ups and health information (allergies to food, required medication, etc.) *
A Pilgrim Lutheran Christian School Handbook with Childcare Addendum has been provided to me or I have read and viewed it on the website or BAND. I understand and agree to the policies found in the handbook (available in the office upon request) *
Weather permitting, K - 4th  Grade students may have a 30-45 minute outdoor play time after school at Elsie Stuhr Park. I give permission for this student to walk to the park. *
Parent Signature *
Date *
Submit
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