LatchKey Enrollment

Select needed time period *

AM PM Both

Students Name *

First Name Last Name

Grade *

Address *

Home Address

Street Address Line 2

Phone Number *

Fathers Name

First Name Last Name

Work Phone

Cell Phone

Mothers Name *

First Name Last Name

Work Phone *

Cell Phone *

Email Address *

example@example.com

Local Doctor or other person to call in case of emergency:

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Other people who may pick up my child or be notified in case of emergency:

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Please see that all emergency numbers are working numbers. If a number is disconnected or changed you let us know immediately!

Parents Consent for Treatment I Hereby authorize the LatchKey staff to act for me according to their best judgement in any emergency requiring medical attention and hereby waive and release West Side Christian Academy and said staff from any and all liablity to any injuries or illness incurred while in LatchKey.

Please check the following.

*

School Employee Enrollment Fee Paid

Signature of Parent or Guardian *

Clear

LatchKey hours are from 7:30am to 8:30am and 3:15pm to 5:30pm. We allow a 15 minute grace period until 5:45 for emergencies only. If your child is not picked up by 5:45pm there will be a late fee charged.

Thid will be determined by school time. The late fee is per child, not family.

If you are going to be late and know it, please let us know. Also, if someone different is to pick up your child, let us know.

** Our policy requires you to sign your child in each morning and out each afternoon. This is a safety procedure.

ANY DISRUPTING THE LATCHKEY PROGRAM WILL BE WITHDRAWN FROM THE PROGRAM.

Signature of Parent or Guardian *

Clear

Complete and sign the WSCA LATCHKEY ENROLLMENT FORM and return to your school site.