Holy Family School Extended Care Registration 2024-2025

Holy Family School Extended Care Registration 2024-2025
Children must be 2 1/2 years of age and fully potty-trained to attend the extended care program. Our state licensing does not permit us to assist children with bathroom functions.

Registration Fee (one student): $35.00

Family Rate: $50.00
Child's Name *

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Child's Age*
Child's Gender*

MaleFemale
Please select one:*

Full-timePart-timeDrop In
My child will be enrolled in:*

Monday/Wednesday A.M. Three Year Old PreschoolTuesday/Thursday A.M. Three Year Old PreschoolTuesday/Wednesday/Thursday P.M. Four Year Old PreschoolMonday - Friday A.M. Four year Old PreschoolKindergarten Prep ProgramKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeNot a student
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Age
Child's Gender

MaleFemale
Please select one:

Full-timePart-timeDrop In
My child will be enrolled in:

Monday/Wednesday A.M. Three Year Old PreschoolTuesday/Thursday A.M. Three Year Old PreschoolTuesday/Wednesday/Thursday P.M. Four Year Old PreschoolMonday - Friday A.M. Four year Old PreschoolKindergarten Prep ProgramKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeNot a student
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Age
Child's Gender

MaleFemale
Please select one:

Full-timePart-timeDrop In
My child will be enrolled in:

Monday/Wednesday A.M. Three Year Old PreschoolTuesday/Thursday A.M. Three Year Old PreschoolTuesday/Wednesday/Thursday P.M. Four Year Old PreschoolMonday - Friday A.M. Four year Old PreschoolKindergarten Prep ProgramKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeNot a student
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Age
Child's Gender

MaleFemale
Please select one:

Full-timePart-timeDrop In
My child will be enrolled in:

Monday/Wednesday A.M. Three Year Old PreschoolTuesday/Thursday A.M. Three Year Old PreschoolTuesday/Wednesday/Thursday P.M. Four Year Old PreschoolMonday - Friday A.M. Four year Old PreschoolKindergarten Prep ProgramKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeNot a student
Child/ren Resides With:*

Father and MotherFatherMotherGuardian/sOther
If separated, does the other parent have legal access:

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name*

First NameLast Name
Father's Name*

First NameLast Name
Mother's Contact Number*
Please enter a valid phone number.
Father's Contact Number*
Please enter a valid phone number.
Mother's Email*
example@example.com
Father's Email*
example@example.com
Mother's Occupation*
Father's Occupation*
Mother's Work Phone Number*
Please enter a valid phone number.
Father's Work Phone Number*
Please enter a valid phone number.
Please list any chronic illness or diability:*
Please list any allergies:*
Please list any authorized medications:*
Please list any medical restrictions:*
Please list any activity restrictions:*
i certify that my child is in good health.*

Clear
LICENSING NOTEBOOK ACKNOWLEDGEMENT
This child care center maintains a licensing notebook of all licensing inspection reports, special investigaton reports, and all related corrective action plans.

This notebook is available for parents to view during regular business hours.

Licensing inspection and special investigation reports from the past two years are available on the Bureau of Children and Adult Licensing website at www.michigan.gov/michildcare.

Please sign in acknowledgment that you have read the above paragraph.
Signature*

Clear

My Products*

Single Student Registration Fee

$35.00

Family Registration Fee

$50.00

Child Add On Fee

$15.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Holy Family School Extended Care Registration 2024-2025

LICENSING NOTEBOOK ACKNOWLEDGEMENT