Extended Day Sign Up Sheet

Extended Day Program hours are 7:00-7:45a.m. & 4:10-6:00p.m.  All students remaining at school after 4:10 p.m. are automatically enrolled in the after school program.  Extended day charges are $8.00 per day, per child.  

1.

My child will...

 

be picked up by 4p.m. in the front lobby   be picked up by 4p.m. in the car line
2.

My Child will stay for extended day or extra-curricular activities on the following day(s):

Monday   Tuesday
Wednesday   Thursday
Friday
3.
*

Student's Name

4.
*

Grade

5.
*

Gender

(1 required)
Male   Female
6.
*

Teacher

7.

Student's Name

8.

Grade

9.

Gender

Male   Female
10.

Teacher

Parent/Guardian Contact Information

11.
*

Name

12.
*

Cell Phone

13.

Home Phone

14.

Work Phone

Parent/Guardian Contact Information

15.

Name

16.

Cell Phone

17.

Home Phone

18.

Work Phone

Acceptable contact for child's pick-up

19.

Name

20.

Phone

21.

Name

22.

Phone

* Email Address: