Child's Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Days of week after school care is needed:
*
Monday
Tuesday
Wednesday
Thursday
Friday
Parent/Guardian Completing Form
*
First Name
Last Name
Parent/Guardian Cell Phone Number
*
Format: (000) 000-0000.
Parent/Guardian Email
*
Your Relationship to Child
*
Mother
Father
Legal Guardian
Other
Child's Father's Name
*
First Name
Last Name
Child's Mother's Name
*
First Name
Last Name
Marital Status of Child's Parents
*
Single
Engaged
Married to child's mother/father
Married to child's stepmother/stepfather
Separated
Divorced
One or both parents are deceased
Other
Date you would like to start After School Care Program:
*
-
Month
-
Day
Year
August 8th, 2024 is earliest date accepted
Elementary School
*
Please Select
Castle Hills Elementary
Coyote Ridge Elementary
Independence Elementary
Memorial Elementary
Pick up time from school:
*
PM
AM/PM Option
Choose your program selection:
*
Full School Year - Aug 2026 to May 2027 - $4,000.00 (one payment)
Month-by-month - $450.00 per month
Submit
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