Extended After School Pick up Registration Form
Please note that this program is only available to our current students. To ensure we have all the necessary information for each student, please complete a separate form for each child you are registering. The cost is $25 for a single day or $150 for the entire month.Extended hours are available from 6-7 PM, Monday through Thursday, except on Fridays.Thank you!
Parent Name
*
First Name
Last Name
Student Name
*
First Name
Last 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
October 2024
November 2024
December 2024
January 2025
February 2025
March 2025
April 2025
May 2025
June 2025
write Days
Note to Staff:
please let us know if you have any questions, concerns or requests.
My Products
*
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Daily Fee
Pick how many days do you need?
$
Free
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Monthly Fee
$
Free
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Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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