Late Parent Pick-up Form
Please complete when a parent picks up their child(ren) late from the program. Late payments are charged to the family at $10 for the first 10 minutes and $2 per minute thereafter. Late Pick-up fees will be divided among the two employees who worked and included as 'PNLP' on their next paycheck.
Name of Child
*
First Name (you may put names of siblings together)
Last Name
Date and time of late pick up
*
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Time
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Minutes
AM
PM
AM/PM Option
Are there additional children you would like to add:
*
Yes
No
Name of Child
First Name
Last Name
Date and time of late pick up
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Month
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Day
Year
Date
Time
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11
12
:
Hour
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59
Minutes
AM
PM
AM/PM Option
Are there additional children you would like to add:
Yes
No
Date and time of late pick up
-
Month
-
Day
Year
Date
Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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35
36
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39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Name of Child
First Name
Last Name
Please note that the late pick-up fees will be split by all those that stayed late.
Employee Submitting Late Pick Up Form
*
First Name
Last Name
Additional Employee that stayed late
*
First Name
Last Name
Additional Employee that stayed late
First Name
Last Name
Additional Employee that stayed late
First Name
Last Name
Submit
Should be Empty: