2025-2026 STAR Care Enrollment Form

STAR Care Enrollment Form - 2025-2026 School Year

K-5 Extended Day School Year Registration
Child's Name*

First NameMiddle NameLast Name
Gender*
Date of Birth*

MonthDayYear
Date
Grade*
Parent/Guardian 1

This parent/guardian will be listed as the primary contact.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Email Type
Primary Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Phone Type*
Alternative Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Alternative Phone Type*
Parent/Guardian 2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Email Type
Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Primary Phone Type
Alternative Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternative Phone Type
Contract Information

Please indicate the schedule of care your child will need on a weekly basis. This will be considered your contracted hours and you will be billed accordingly. You will be charged monthly based on this registration form regardless of sick days and absences.
RATES:

Mornings - 6:30-8:30: $10.00/morning

Afternoons - 3:00-6:00: $13.00/afternoon

Full Day Package (Morning and Afternoon): $17.00/day

Non-School Day - 8:30-3:00: $35.00/day
At the start of the Fall 2025 school yearAs Soon As PossibleOther

Please indicate days and times that your child will be at Star Care by placing an x in the corresponding box*

Is there anything else you'd like us to know about the start date or your schedule.

Enter coupon

STAR Care Enrollment Form - 2025-2026 School Year