Extend After School Pick-up Time

Extended After School Pick up Registration Form

Please note that this program is only available to our current students. In order to ensure that we have all of the necessary information for each individual student, please complete a separate form for each child that you are registering, $25 for a single day or $150 monthly.
Parent Name*

First NameLast Name
Student Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Would You like to register your child for daily or Monthly

Daily Cost $25 (pay by this registration)Monthly Cost $150.00 Monthly (pay by this registration)
Monthly Extended After School Program

September 2024October 2024November 2024December 2024January 2025February 2025March 2025April 2025May 2025June 2025
write Days
Note to Staff:
please let us know if you have any questions, concerns or requests.

My Products*

Daily FeePick how many days do you need?

$ Free Quantity

Monthly Fee

$ Free Quantity

Enter coupon

Total

$0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Extended After School Pick up Registration Form