ETC 2023-24 School Year Registration Form
Hello from your ETC Staff!  

THERE ARE SOME IMPORTANT NOTICES ABOUT OUR PROGRAM LISTED BELOW, SO PLEASE READ CAREFULLY:

At this time, we are ONLY offering Full-time enrollment for each child.  

COST:
Non-Refundable Registration Fee:  $20.00 per Family
Monthly Tuition Fees:
1st Child: $200.00 per month
2nd Child: $180.00 per month
3rd Child: $180.00 per month
4th Child: $180.00 per month

GATE students at Simmons Elementary will be provided bus transportation to their "home school" in order to attend ETC there, if the parent wishes to sign the student up for that ETC site.  If the child needs to stay after school for a club or project, they will NOT be able to attend the ETC program at Simmons.

The form below will be print-formatted to look like our regular registration form. Your signature at the bottom of this document will serve as the official signature and you will not have to sign anything in person.  

We are a state licensed child care center and are only allowed to serve a limited number of children at each school. These spots will be filled on a first-come first-served basis.  If you complete this form and there is not a spot open within the needed age group at the required school, we will notify you of being placed on a wait-list for that group by July 20, 2023.

After you have completed this form and it is reviewed by our office staff, you will receive a confirmation email that will give you instructions regarding payment of the $20 registration fee per family. Students are NOT guaranteed a spot in our program until the confirmation is received and the fee is paid. Please allow up to 3-4 business days for this process and for you to receive the confirmation email. When you submit this form, you will get an automatic email of your answers.


Follow our Facebook page at "WCPS Explorer Time Company - ETC" for reminders and announcements. The Facebook feed is also available on our ETC web page under "Departments" on the school district website and does not require you to have a Facebook account to view it.

Thank you for taking the time to complete this form completely and we look forward to seeing your child(ren) in the fall!
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Email *
Has your family participated in the ETC program previously? *
1st Parent/Guardian's First Name *
1st Parent/Guardian's Last Name *
1st Parent/Guardian's Email (if different from email submitted above)
1st Parent/Guardian's Phone Number *
1st Parent/Guardian's Address: Street *
1st Parent/Guardian's Address: City *
1st Parent/Guardian's Address: State *
1st Parent/Guardian's Address: Zip Code *
1st Parent/Guardian's Employment *
1st Parent/Guardian's Work Phone Number *
2nd Parent/Guardian's First Name (type NA to second guardian questions if none) *
2nd Parent/Guardian's Last Name *
2nd Parent/Guardian's Email
2nd Parent/Guardian's Phone Number *
2nd Parent/Guardian's Address: Street *
2nd Parent/Guardian's Address: City *
2nd Parent/Guardian's Address: State *
2nd Parent/Guardian's Address: Zip Code *
2nd Parent/Guardian's Employment *
2nd Parent/Guardian's Work Phone Number *
How many children are you enrolling in ETC? *
Which ETC site are you enrolling 1st Child in? *
1st Child's First Name *
1st Child's Last Name *
1st Child's Date of Birth *
MM
/
DD
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YYYY
How old is the 1st child as of August 1st, 2023? *
What grade will the 1st child attend? *
1st Child's Teacher (type NA if not known yet) *
Who does the 1st Child reside with? *
Does the 1st child have any of the following plans? *
Required
1st Child's Doctor's Name (First and Last) *
1st Child's Doctor's Phone Number *
1st Child Preferred Hospital Name *
1st Child's Insurance Carrier (cannot be left blank) *
1st Child's Insurance Policy Number (cannot be left blank) *
1st Child's Daily Medications? *
1st Child's Allergies? *
My electronic signature and check mark signifies the following assurances for medical assistance:   As the lawful parent or guardian of the above child, a minor child of whom I have custody and control, do hereby authorize the agents and employees of the Woodford County Board of Education to procure such emergency medical treatment as may be reasonably necessary to provide for the health and well-being of said minor child at any time that such minor is in the custody of said Woodford County Board of Education employee while in attendance at school, in attendance at the Explorer Time Company enrichment program, or while in route to or from a school.  I further authorize the said agents or employees of the Woodford County Board of Education to sign any and all consents required by physicians or hospitals in connection with said emergency treatment, including but not limited to the administration of anesthesia, disposal of tissue, the taking of photographs, moving pictures, television pictures, etc., the drawing of blood samples, and the performance of such additional operations or procedures as are considered necessary or desirable in the judgment of the attending physician or hospital authorities. In connection herewith, the Woodford County Board of Education agrees that it will direct its agents and employees to make a reasonable attempt to contact the parent or guardian of the child if emergency medical care or treatment is necessary and that the above authorization and consent is for the purpose of providing emergency care and treatment for the child when the parent or guardian cannot be located. *
Required
1st Child MAY be photographed. *
1st Child MAY have supervised internet access. *
1st Child MAY watch PG rated movies or shows. *
Do you have more children to register? *
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