Extended Day Program Application Form

If you've read the Extended Day Program information on the previous page and would like to register your child or children, please complete the form below.

Child Information

Child #1

Child's Name: *

Please enter the child's first and last name.

Grade: *

Full-time or Part-time: *

Full-time

Part-time

Child #2

Child's Name:

Please enter the child's first and last name.

Grade:

Full-time or Part-time:

Full-time

Part-time

Child #3

Child's Name:

Please enter the child's first and last name.

Grade:

Full-time or Part-time:

Full-time

Part-time

Child #4

Child's Name:

Please enter the child's first and last name.

Grade:

Full-time or Part-time:

Full-time

Part-time

Parent Information

Parent/Guardian Name(s): *

Agreement

By checking the box below, I acknowledge that I have read and understand the schedule and guidelines set forth for the Extended Day Program.

Acknowledgement of Schedule and Guidelines: *

Yes, I understand.

Comments:

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