Extended Day Application 2022-2023

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All information gathered will be stored and maintained in a secure folder within our schools database.

2022/2023 Rates:

○ $300/month for Full Week for 1 student
○ $450/month for Full Week for 2 or more students
○ $125/month for 1 student on Wednesdays only
○ $150/month for 2 or more students on Wednesdays only

Extended Day Important Dates:

○ September 1st – First Day of Extended Day
○ June 6th – Last Day of Extended Day

Dates with No Extended Day Service:

○ December 22nd (Winter break begins)
○ March 31st (Spring Break begins)

○ May 26th (Memorial day weekend)

Terms & Conditions:

● Due to cost constraints, written and telephone reminders cannot be provided.
● Failure to pay on or before a due date is presumed to be a cancelation of your child’s participation in the program; his or her seat will then be made available to wait-listed students.
● Cashiers check, money orders, and cash are acceptable forms of payment. If you would like to pay via credit or debit card, payment can be made in the Main Office during office hours.
● If you would like more information, please reach out to Lissette Guerrero: lguerrero@distinctiveschools.org
● We regret that no refunds are available for Extended Day Payments.
● The CICS-Distinctive Schools Code of Conduct applies during your child’s participation in the Extended Day Program. More than 3 Code of Conduct violations may result in a student’s disqualification from the program.
● Students must be picked up after the Program NO LATER THAN 6:00pm. Each student’s continued participation in the program is contingent upon a parent or guardian’s timely pick-up of the student by 6:00pm of each day the program is in session. Failure to make timely pick-ups may disqualify future participation.

All information collected is confidential and securely stored

Extended Day rates will be adjusted for the following months. Please mark your calendars.

For the Month of November:
Payment Due by Friday October 14th.
$125 - Wednesdays Only for 1 Child
$150 - Wednesdays Only for 2 or more Children
$240 -Full Week for 1 Child
$360 -Full Week for 2 or more Children

For the Month of December:
Payment due by Friday November 11th
$95 - Wednesdays Only for 1 Child
$115 – Wednesdays Only for 2 or more Children
$240 – Full Week for 1 Child
$360 – Full Week for 2 or more Children

For the Month of January:
Payment due by Dec. 16tth
$95 – Wednesdays Only for 1 Child
$115 – Wednesdays Only for 2 or more Children
$225 – Full Week for 1 Child
$340 – Full Week for 2 or more Children

For the Month of April:
Payment due by March 10th
$95 – Wednesdays Only for 1 Child
$115 – Wednesdays Only for 2 or more Children
$225 – Full Week for 1 Child
$340 – Full Week for 2 or more Children

For the Month of June:
Payment due by May 12th
$50 – Wednesdays Only for 1 Child
$70 – Wednesdays Only for 2 or more Children
$60 – Full Week for 1 Child
$90 – Full Week for 2 or more Children

Email *

I have read and understand the 2022-2023 Terms and Conditions of the CICS Irving Park Extended Day Program *

I agree to the terms & conditions

Other:

Required

I understand that CICS Irving Park Extended day program is not licensed or regulated by DCFS. If you would like more information on Rule 377 you may request additional information. *

I agree to the terms & conditions

Required

Extended Day Enrollment Form

The enrollment form must be completed for each child you are enrolling!

Child's Full Name *

Date of Birth *

YYYY

Age *

Sex *

Male

Female

Prefer not to choose

Grade 2022/2023 School Year *

Allergies *

Medications *

Any other health issues *

Parent/Guardian Full Name *

Relationship *

Home Address *

Phone Number *

Email *

Extended Day Enrollment Choice *

Full Week

Wednesday Only

Emergency Contact Information

Please indicate the individuals that are authorized to pick up your child(ren) in your absence:

#1 Full Name *

#1 Relationship to Child *

#1 Phone Number *

#2 Full Name

#2 Relationship to Child

#2 Phone Number

#3 Full Name

#3 Relationship to Child

I hereby authorize any and all necessary medical care determined to be necessary for the welfare of my child while said child is under the care of CICS Irving Park. *

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

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