Before/After Care Re-Enrollment Form

Cornerstone Classical Academy Extended Care Program Re-Enrollment Form
Re-enrollment deposit fee payable through MySchoolBucks:

One Scholar: $50; Two Scholars: $90; Three Scholars: $120
Scholar #1 Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Grade (2024-25 school year)
Does your child have any allergies or require an EpiPen?
If Yes, please explain:
Scholar #2 Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Grade (2024-2025 school year)
Does your child have any allergies or require an EpiPen?
If Yes, please explain:
Scholar #3 Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Grade (2024-2025 school year)
Does your child have any allergies or require an EpiPen?
If Yes, please explain:
Legal Guardian/Parent Contact

First NameLast Name
Mobile Number
E-mail
example@example.com
Please list those that are authorized to pick up your child/children other than the parents:

First/Last NameRelationshipMobile Number
Please list those that are authorized to pick up your child/children other than the parents:

First/Last NameRelationshipMobile Number
Re-Enrollment Session
Please email info@cornerstoneclassical.org with any questions.
Should be Empty:

Cornerstone Classical Academy Extended Care Program Re-Enrollment Form