NVCA EXTENDED CARE 2025-2026

EXTENDED CARE

Extended Care is state-licensed and available for students in Preschool through 5th grade. To ensure compliance with state regulations, the following information is required for your child to attend.
Student Information
Name*

First NameLast Name
Date Of Birth*
Grade For The 2025-2026 School Year*
Gender

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is child allergic to food or other substances?*
Is there any physical condition that we should be aware of and what precautions should be taken?*
Parent/Guardian Information
In case of injury, ilness, or emergency, the Parent/Guardian will be contacted in the order listed below:
Parent/Guardian #1*

First NameLast Name
Primary Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
PARENT/GUARDIAN #2*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
I authorize the following individuals to collect my child from the facility in case of emergency or if I cannot be contacted:

Two contact persons are required.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
THE FOLLOWING INDIVIDUAL(S) MAY NOT REMOVE MY CHILD FROM THE FACILITY:

Name(s):Name(s):
IMMUNIZATION RECORD/EXEMPTION FORM*

Cancelof
HEALTH CARE PROVIDER*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Extended Care Program Guidelines

Brightwheel:
Parents must create a Parent Account on the BrightWheel app or website.

Personal Items:
Personal items such as games, toys, trading cards, and balls are not allowed in Extended Care.

Medication:
Extended Care staff are not authorized to dispense medication under any circumstances.

Automatic Check-In:
Any student not picked up within 15 minutes of dismissal will be automatically signed into Extended Care.

Daily Pick-Up & Late Fees:
Extended Care ends promptly at 5:00 p.m.
Students picked up after 5:00 p.m. will incur a late fee of $5 per minute.
A parent or authorized guardian must sign out their child each day. Failure to do so will result in a full-day charge.
Fees:
$25 annual registration fee per student
$4 per half hour or $8 per hour
Charges will be billed directly to your FACTS account
INFORMED CONSENT AND ACKNOWLEDGMENT

I hereby give my approval for my child’s participation in any and all activities prepared by North Valley Christian Academy during morning and extended care. I give my child permission to be relocated to any room, playground or building on campus if needed. In exchange for the acceptance of said child’s candidacy by North Valley Christian Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless North Valley Christian Academy and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against North Valley Christian Academy including all coaches, teachers, affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
MEDICAL RELEASE AND AUTHORIZATION

As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the North Valley Christian Academy and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Signature
Should be Empty:

EXTENDED CARE

Student Information

Parent/Guardian Information

I authorize the following individuals to collect my child from the facility in case of emergency or if I cannot be contacted: