Extended School Care New Family Registration for the 2024-2025 School Year.
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Please complete the form separately for each child you wish to register for the Extended School Care Program for the 2024-25 school year.
Child's first name *
Child's last name *
Child's date of birth (MM/DD/YEAR) *
Indicate the school your child will be attending for the 2024-25 school year. *
Grade (as of 9/2024) *
Child's Address  (#, street) *
Child's Address  (town, state, zip code) *
First Name of enrolling parent/guardian *
Last Name of enrolling parent/guardian *
Parent/Guardian's phone number *
Parent/Guardian's email address *
Child's Gender *
Does your child have an IEP or 504 plan? *
Do you have a custody agreement, requiring the attention  of staff at pick-up time?  (Please submit a copy of any custody order along with enrollment paperwork.) *
Does your child require medication during program hours?  (Medication administration form/medication must be submitted on the first day of care.) *
Does your child have asthma, requiring an inhaler be kept on hand at all times?  (Action plan required at the time of enrollment.  Please submit a medication administration form/medication on the first day of care.) *
Does your child have an allergy, requiring an Epi-pen be kept on hand at all times?  (Action plan required at the time of enrollment.  Please submit a medication administration form/medication on the first day of care.) *
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