Drop-in // Flex Care Schedule Form

** 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. The payment for flex care days is due Friday prior to the week of care.

Child's Name*

First NameLast Name

Which ABC Care Center does your child attend?*

Child's Grade*

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

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 will be needed*

	Both Before & After	Before Care only	After Care only
Monday
Tuesday
Wednesday
Thursday
Friday

Would you like to register for additional weeks of flex care?*

YesNo

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

Date

Days care will be needed

	Both Before & After	Before Care only	After Care only
Monday
Tuesday
Wednesday
Thursday
Friday

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

Date

Days care will be needed

	Both Before & After	Before Care only	After Care only
Monday
Tuesday
Wednesday
Thursday
Friday

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

Date

Days care will be needed

	Both Before & After	Before Care only	After Care only
Monday
Tuesday
Wednesday
Thursday
Friday

Parent Signature*

Clear

Date*

Date

Comments:

Drop-In // Flex Care Schedule Form