Holy Family School Extended Care Registration 2026-2027

Holy Family School Extended Care Registration 2026-2027
Children must be 2 1/2 years of age and fully potty-trained to attend the extended care program. Our state licensing does not permit us to assist children with bathroom functions.

Annual Registration Fee (one student): $35.00

Annual Family Rate: $50.00

[Adding a second student after initial singular student] : $15.00
Child/ren Resides With:
If separated, does the other parent have legal access:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian 1's Name

First NameLast Name
Parent / Guardian 2's Name

First NameLast Name
Parent / Guardian 1's Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Guardian 2's Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Guardian 1's Email
example@example.com
Parent / Guardian 2's Email
example@example.com
Parent / Guardian 1's Occupation
Parent / Guardian 2's Occupation
Parent / Guardian 1's Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Guardian 2's Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
First Child's Name

First NameLast Name
First Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
First Child's Age
First Child's Gender
Please select one:
My child is/will be enrolled in:
For First Child, please list any chronic illness or disability :
For First Child, please list any allergies:
For First Child, please list any authorized medications:
For First Child, please list any medical restrictions:
For First Child, please list any activity restrictions:
For First Child, I certify that my child is in good health.
I have another child to register:
Second Child's Name

First NameLast Name
Second Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Second Child's Age
Second Child's Gender
Please select one:
My child is/will be enrolled in:
For Second Child, please list any chronic illness or disability :
For Second Child, please list any allergies:
For Second Child, please list any authorized medications:
For Second Child, please list any medical restrictions:
For Second Child, please list any activity restrictions:
For Second Child, I certify that my child is in good health.
I have a third child to register:
Third Child's Name

First NameLast Name
Third Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Third Child's Age
Third Child's Gender
Please select one:
My third child is/will be enrolled in:
For Third Child, please list any chronic illness or disability :
For Third Child, please list any allergies:
For Third Child, please list any authorized medications:
For Third Child, please list any medical restrictions:
For Third Child, please list any activity restrictions:
For Third Child, I certify that my child is in good health.
I have a fourth child to register:
Fourth Child's Name

First NameLast Name
Fourth Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Fourth Child's Age
Fourth Child's Gender
Please select one:
My child is/will be enrolled in:
For Fourth Child, please list any chronic illness or disability :
For Fourth Child, please list any allergies:
For Fourth Child, please list any authorized medications:
For Fourth Child, please list any medical restrictions:
For Fourth Child, please list any activity restrictions:
For Fourth Child, I certify that my child is in good health.
LICENSING NOTEBOOK ACKNOWLEDGEMENT
This child care center maintains a licensing notebook of all licensing inspection reports, special investigaton reports, and all related corrective action plans.

This notebook is available for parents to view during regular business hours.

Licensing inspection and special investigation reports from the past two years are available on the Bureau of Children and Adult Licensing website at www.michigan.gov/michildcare.

Please sign in acknowledgment that you have read the above paragraph.
Signature

My Products

Single Student Registration Fee

Extended Care

$35.00

Family Registration Fee

Extended Care

$50.00

Extended Care Child Add-On Fee

Extended Care - Only to be used if 1st student already registered and family is adding an additional student later in the year.

$15.00

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Additional Forms Acknowledgement
I understand that there are additional forms that must be filled out in order to complete my child(ren)'s Extended Care Registration, including the "Child Information Record", the "Parent Notification of the Licensing Notebook", and the "New Monthly Schedule" spreadsheet. They can be found within the FACTS Family Portal. I will complete them promptly.
Signature
Should be Empty:

Holy Family School Extended Care Registration 2026-2027

LICENSING NOTEBOOK ACKNOWLEDGEMENT

My Products*

Additional Forms Acknowledgement

My Products