Extended Care Registration

INSTRUCTIONS:

Please complete the information below to register your student(s) for Extended Care. Extended Care is available for students in Pre-K through 8th grade.

Extended Care Rates:

	Pay in Full	9 monthly pymts.*	11 monthly pymts.*	18 bi-monthly pymts*
	by Aug. 15th	(Aug. 15th - Apr. 15th)	(June 15th - Apr. 15th)	(Aug. 15th - Apr. 30th)
AM Care	$ 900.00	$ 100.00	$81.82	$50.00
PM Care	$ 1,300.00	$ 144.44	$118.18	$72.22
AM & PM Care	$ 2,000.00	$ 222.22	$181.82	$111.11

* All monthly payments must be paid using FACTS (automatic payment plan)

Extended Care Information:

OPTIONAL CARE: Extended Care is optional for K to 8th grade students for the additional fee listed above.
DAYS: The fee for Extended Care includes all 180 regularly scheduled school days (including half-days).
DROP IN: Those using drop-in Extended Care greater than two times per week must sign up for an Extended Care plan.
SCHOOL HOLIDAYS: Extended Care will be available on school holidays for students already enrolled in the extended care program at $7.00 per student per hour.
NO CARE: There will be NO Extended Care available on the following school holidays: September 1, September 23, October 31, November 26-28, December 24-26, December 31, January 1, February 13, and April 6.
SCHOOL CLOSURES: If school is closed due to inclement weather, there may be no extended care offered due to dangerous road conditions around the school.

Student #1 Name

First NameLast Name

Student #1 2025-2026 Grade Level

Student #2 Name

First NameLast Name

Student #2 2025-2026 Grade Level

Student #3 Name

First NameLast Name

Student #3 2025-2026 Grade Level

Student #4 Name

First NameLast Name

Student #4 2025-2026 Grade Level

Desired Extended Care Option

AM OnlyPM OnlyAM & PM

Please select the payment option you intend to use:

Pay in full by August 159 monthly payments (Aug. 15 - Apr. 15)11 monthly payments (June 15 - Apr. 15)18 bimonthly payments (Aug. 15 - Apr. 30)

Parent/Guardian Name

First NameLast Name

Parent/Guardian Email Address

example@example.com

Parent/Guardian Phone

Please enter a valid phone number.

Note: All emergency contacts and those listed on the authorized pick up list should be listed through your FACTS Family Portal.

ASSUMPTION OF RISK/PERMISSION TO TREAT:

I/We agree that my/our student is of good health and free from any medical condition, physical or mental, which could interfere with my student's ability to use Extended Care.

I/We understand that in the event of an injury, illness, and/or accident involving my/our student, I authorize Timberlake Christian School and its employees to seek medical attention or care or to transport my/our student to a medical facility or hospital. I agree that Timberlake Christian School has no obligation to seek or provide such medical care to my/our student. In the event Timberlake Christiasn School seeks transportation and/or medical care for my/our student, I agree to pay all related charges and to hold Timberlake Christian School harmless from all charges. I/We understand that Timberlake Christian School will make every effort to contact me prior to seeking treatment for my/our student, but the medical staff will not withhold any of the above treatment if Timberlake Christian School cannot reach me.

ELECTRONIC SIGNATURE VERIFICATION:

I certify that the signature below is a representation of my signature, the parent/guardian, as if it were written on paper.

PARENT/LEGAL GUARDIAN CONSENT:

As the parent and/or legal guardian of the student identified above, I agree that I have carefully read, undestand, and consent to this agreement.

Parent/Guardian Signature*

Date