After School Program Enrollment Form

Extended Care Enrollment Form
Ford's Chapel Learning Center is pleased to offer our Extended Care Program for those families that need care for their children beyond the normal school day.

Please complete and submit one form per student being enrolled in the Extended Care Program.
Student's Name*

First NameLast Name
Birth Date

MonthDayYear
Date
Guardian's Name*

First NameLast Name
Parent's Phone Number*

Area CodePhone Number
Parent's Email*
Guardian's Name*

First NameLast Name
Parent's Phone Number*

Area CodePhone Number
Parent's Email*
example@example.com
Indicate the day(s) that you anticipate utilizing the Extended Care Program:*

MondayTuesdayWednesdayThursdayFridayAs Needed ($25 per day)
Please note any known allergies:
Please specify each person, including the name of parents, who has permission to pick up your child from the Extended Care Program.
Authorized Person 1:

First NameLast Name
Phone Number 1:

Area CodePhone Number
Authorized Person 2:

First NameLast Name
Phone Number 2:

Area CodePhone Number
Authorized Person 3:

First NameLast Name
Phone Number 3:

Area CodePhone Number
Authorized Person 4:

First NameLast Name
Phone Number 4:

Area CodePhone Number
Extended Care Fees and Policies
EXTENDED CARE RATES

Monthly Rates
● Monthly rate is $20/day
● No credits or refunds will be given.
● Your monthly invoice will reflect the number of days your student was scheduled to be in school for that month.

Drop-in Rates
● Drop-in rate is $25/day.
● No credits or refunds will be given.
● Same day drop-ins are on a first come, first serve basis based on the number of spots we have available.
● For emergency drop-ins, please contact the office at 256-864-0888 or email us at fordschapellc@gmail.com. If
you do not have confirmation from our office, your child does not have a spot in extended care that day.

Inclement weather, illness, and absences will not be reflected in the invoice and will not be refunded or credited.

● Late fees will be applied to children picked up after 4:00. ($1 per minute/per child)
● There will be no car rider line for Extended Care. Children must be picked up and signed out at the FCLC office door (located at the back of the building).
● Snacks will be provided each day by FCLC’s Extended Care and donations are appreciated. Please send a reusable water bottle clearly labeled with their name.
● We cannot release your child to anyone NOT listed on the registration form or Extended Care form without prior written approval from you. Please let us know in writing or by email (fordschapellc@gmail.com) if someone other than you will be picking up your child. They will need to have a valid picture ID with them.
● Extended Care Tuition invoice will be emailed either in a joint invoice with the school day tuition or in its own invoice.
● Bounced checks will result in a $30.00 returned check fee.
Supplies needed for extended care:
● Diapers/Pull-Ups should be sent in to cover the time your child is in extended care.

Supplies needed for naptime:
We encourage all students to rest during this time.
● Ages 2 & Up: Roll Up Nap Mats - We provide nap cots but ask that you send in a roll up style nap mat. Nap mats will be sent home at the end of each week to be washed.
● For infants Sleeping in Cribs: Blankets - We provide crib sheets, which are changed and washed daily. We ask that you provide your own blanket and pillow if you would like.
● Comfort items necessary for rest-time may be sent in with nappers of all ages.
I have read and understand the Fees and Policies contained here.*

Agree
I give Ford's Chapel Learning Center permission to bill my student's account for the Extended Care Program services indicated on this Enrollment Form, according to the Statement of Fees.*

Agree
Should be Empty:

Extended Care Enrollment Form

Extended Care Fees and Policies