Extended Care Enrollment Form

EXTENDED CARE ENROLLMENT FORM
Child Information
Child Name *

First Name Last Name
Grade *
Parent / Guardian Information
Parent / Guardian Name *

First Name Last Name
Email Address *
example@example.com
Phone Number
Extended Care Program Information
Please Select Program *

YES, my child will be attending Legacy’s MORNING CARE PROGRAM. YES, my child will be attending Legacy’s AFTER SCHOOL CARE PROGRAM.
Days Available *

Mon Tue Wed Thu Fri
Days Available *

Mon Tue Wed Thu Fri
YES, my child will be attending Legacy’s SIBLING CARE PROGRAM (Only available to students with older siblings)
Please select from the following
Please Select One
Parent / Guardian Signature *

Clear
Legacy Christian Academy

27680 Dickason Drive
Valencia, CA 91355
Phone: 661.257.7377
Should be Empty:

EXTENDED CARE ENROLLMENT FORM