Drop-in // Flex Care Schedule Form

This form is used for all Drop-In, Flex Care and Added Care requests. Drop-in and flex care is for those that do not have a regular weekly schedule. Added care is for those that have a part-time regular weekly schedule.

All requests are contingent on availablity

Flex Care: Forms are due by midnight on Tuesday the week prior to needing care. Forms received after Tuesday at midnight the week prior to needing care will be charged the drop in rate instead of the flex rate.

Added Care: Forms are due by 4PM the business day prior to the day being requested (if care is needed on Monday the deadline is Friday by 4PM)

Payment for flex/Drop-in and added care is due either the Friday before the week care is requested or at time of request whichever is applicable.

Child's Name*

First NameLast Name

Which School does your child attend?*

Child's Grade*

Please list name of any siblings who will need same flex care schedule:

Sibling Grade

Parent's Name*

First NameLast Name

Parent's Phone Number*

Please enter a valid phone number.

Parent's Email*

example@example.com

Please list the Monday date for the week you are registering for flex care:*

Date

Days care is being requested (approval of care is contingent on availability at the center)*

	Before Care	After Care
Monday
Tuesday
Wednesday
Thursday
Friday

Would you like to request additional weeks of care?*

YesNo

Please list the Monday date for the week you are requesting care:

Date

Days care is being requested (approval of care is contingent on availability at the center)

	Before Care	After Care
Monday
Tuesday
Wednesday
Thursday
Friday

Please list the Monday date for the week you are requesting care:

Date

Days care is being requested (approval of care is contingent on availability at the center)

	Before Care	After Care
Monday
Tuesday
Wednesday
Thursday
Friday

Please list the Monday date for the week you are requesting care:

Date

Days care is being requested (approval of care is contingent on availability at the center)

	Before Care	After Care
Monday
Tuesday
Wednesday
Thursday
Friday

Parent Signature*

Date*

Date

Comments:

Drop-In // Flex Care Schedule Form