Before and After School Care Registration Form

Before and After School Care Registration

We invite parents to complete our before and after school care registration form for the Willie Jeffries School of Excellence (WJSE). Please fill out this pre-registration form to be considered for our K-6 full and part-time spaces. Once submitted, we will review your application and get back to you with further details.
Parent #1 Name*

First NameLast Name
Parent #2 Name

First NameLast Name
Child's Name*

First NameMiddle NameLast Name
Child's Birth Date*

MonthDayYear
Child's Gender*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary E-mail*
example@example.com
Secondary E-mail
(optional)
Preferred Start Date
Parent #1 Primary Phone Number
Parent #2 Primary Phone Number
Before School Care

Our before school care program starts at 6:30 am, providing a convenient option for parents who work early mornings. You can drop off your student, ensuring they have a safe and supportive environment before school begins.
After School Care

Our after school care program provides a secure and engaging environment for students until 6:00 pm. This service is ideal for parents with later work schedules, offering peace of mind knowing their children are well cared for after school hours.
Please submit Proof of Income

Before School Care and After School Care are Income based to fit the financial needs of our families.
Cancelof
Preferred Care Schedule*
Exceptional Childcare Needs
Additional Comments
If not full-time, please indicate preferred schedule.
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Before and After School Care Registration

Before School Care

After School Care