Kellyville Schools 2022-2023 Latchkey Program Enrollment Form

Kellyville Schools 2022-2023 Latchkey Program Enrollment Form
Afternoon Hours: 3:00 - 6:00 PM

Cost: $0.70 for any part of 15 minutes

Late Fees: A late pick-up charge will be assessed beginning at 6:00 PM. Late fee rates are $1.00 per minute, per child that is picked up late. (3rd time picking up late will result in services being discontinued.)

Invoices are emailed bi-weekly on Tuesdays and payment is due Friday of the same week. A $10.00 LATE FEE will be charged if not paid by due date. Delinquent accounts will result in discontinued latchkey services. Cash, money order, or personal checks are accepted.

All latchkey students, both Upper & Lower Elementary, will be in the Lower Elementary from 3:00 p.m through 6:00 p.m. and can be picked up at the Lower Elementary.

One afternoon snack and drink are included in the above price. Homework time/help is provided in the afternoon. Any behavior issues will be addressed with the student and parent. Continual behavior problems will result in discontinuing Latchkey services.
I have read and agree to the guidlines listed above: *

(Parent/Guardian) Clear
Telephone number for text alerts: *

Area CodePhone Number
Email address for invoice delivery:*
example@example.com
Student #1 Name: *
Student #1 Grade:*
Student #2 Name:
Student #2 Grade:
Student #3 Name:
Student #3 Grade:
Student #4 Name:
Student #4 Grade:
When will student(s) attend?

MorningAfternoonBoth Morning & Afternoon
Parent/Guardian 1 Name: *
Mobile Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Parent/Guardian 1 Name:
Mobile Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact(s) Name/Number:
Emergency Contact(s) Name/Number:
Persons allowed to pick up student(s):
Should be Empty: