2025-26 Student Extended Care Contract

Parent Name*

First NameLast Name
Parent Email*
example@example.com
How many students are you enrolling in our extended care program?

One studentTwo studentsThree studentsFour students
Student #1*

First NameLast Name
Student #1's Grade Level
Student #1 will need extended care on the following weekdays:

MondayTuesdayWednesdayThursdayFriday
Student #2

First NameLast Name
Student #2's Grade Level
Student #2 will need extended care on the following weekdays:

MondayTuesdayWednesdayThursdayFriday
Student #3

First NameLast Name
Student #3's Grade Level
Student #3 will need extended care on the following weekdays:

MondayTuesdayWednesdayThursdayFriday
Student #4

First NameLast Name
Student #4's Grade Level
Student #4 will need extended care on the following weekdays:

MondayTuesdayWednesdayThursdayFriday
How would you like to be billed for extended care?

Pay in fullPay in two paymentsPay monthly
Parent Signature
Today's Date

MonthDayYear
Date
Should be Empty: