Polar Bear Care Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Supervised care for your student 2 hours after school Monday through Thursday (4:00 pm - 6:00 pm) and 4 hours after school on Friday (2:00 pm - 6:00 pm).

Polar Bear Care services begin on August 26, 2019 and end on May 26, 2020.

The cost for this service is $65 per month.

Payment is due on the 1st of each month prior to receiving after school care services.

FRIDAYS ONLY - Registration fee not required.

Email *

Select Care Days *

Monday-Thursday Only (4- 6 pm)

Fridays only (2- 6 pm)

Everyday Monday- Friday

Other:

Required

Student Name *

Student Grade *

6th

7th

8th

9th

Does student have any medical conditions? *

Yes. If yes, Polar Bear Care Coordinator will review student's medical file.

No.

Primary Contact Person Name (After School Hours) *

Relationship to Student *

Parent

Grandparent

Family Friend

Phone Number *

If you are in need of financial assistance for Polar Bear Care, please provide information below that would be beneficial in determining whether or not you qualify.

After School Care Agreement *

I agree to submit payment on the first of each month. I understand that there is no daily rate. If after school plans change, I will notify the school before the end of the month if child will not be returning to after school care the following month.

I understand that Polar Bear Care is an extension of the school day and that the Student Code of Conduct still applies.

I agree to pick up my student(s) on time. I will notify the school if there is a delay and I understand that late pick-up is subject to an additional fee of $5 per 15 minute interval.

Required

Clear form

Never submit passwords through Google Forms.

This form was created inside of Compass Rose Education, Inc.. Report Abuse

Forms