Extended Care Registration 2022 -2023
Please complete this form and pay using the online link your Extended Care registration fee.  The registration form and fee are due the first day your child attends Extended Care. The fee is $65 per family until September 1st, when the fee becomes $75.00 per family.

This form is vital to helping us provide fast, accurate and caring attention to your child in the case of an emergency. If your child uses Epi-pens, inhalers, Benadryl, etc., let us know on the form. Please fill it out completely and in clear, easy to read writing. Keep us updated on any changes throughout the year.
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Email *
Child 1 *
Child 1 Grade *
Child 1 Birthdate *
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Child 2
Child 2 Grade
Child 2 Birthdate
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Child 3
Child 3 Grade
Child 3 Birthdate
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Child 4
Child 4 Grade
Child 4 Birthdate
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