Monthly Extended Care Agreement

This from indicates that you are committing to the terms of the Monthly Extended Care rates as outlined in the Parent Student Handbook. This form must be received before the fifth business day of the month along with payment in full for all participating under this agreement. Please be advised that you must fill this enrollment form out each month. Forms for the following month will begin to be accepted as of the 20th of the previous month. i.e. Forms for December can begin to be submitted on or after November 20th and no later than December 6th.

Parent Name Parent Name First Last
Email
Indicate the Month you are enrolling in full-time extended care (3:30 pm to 5:30 pm)

Indicate the Month you are enrolling in full-time extended care (3:30 pm to 5:30 pm) August September October November December January February March April May June
Child's Name Child's Name First Last
Please list the names of the students participating in this agreement.

First child is charged at $300.
Child's Name (Second if applicable) Child's Name (Second if applicable) First Last
Each additional child will be charged $250
Child's Name (Third if applicable) Child's Name (Third if applicable) First Last
Each additional child will be charged $250
Child's Name (Fourth if applicable) Child's Name (Fourth if applicable) First Last
Each additional child will be charged $250
Please indicate how you will pay.

Please indicate how you will pay. Check delivered to school office by fifth business day of the month Credit Card Authorization by fifth business day of the month Cash payment at school office by fifth business day of the month
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.