Before and After School Registration

    Student information
    Student #1 (required)

    Student #2

    Student #3

    Student #4

    Student #5

    Family Contact Information (required)
    Address: ,
    , Michigan,

    Parent Contact Information:
    Mother:



    Father:



    Child Care Needed
    Hours: AM 6:30-8:15 PM 3:20-6:00
    *Drop off times between 6:30-7:15 am must be scheduled ahead of time. Thank you.

    Session (required):
    BeforeAfterBoth

    Please indicate what times and days of the week you will need child care.

    Monday Tuesday Wednesday Thursday Friday

    Before and After Care Fees:
    1 child: $10/ hour
    2 children: $12/ hour
    3+ children: $15/ hour

    Late Pick Up Fees are as follows:
    After 6:00 PM: $1.00/minute
    After 6:30 PM: $5.00/minute

    Families will be invoiced every four weeks. Payment is expected 10 days after receipt of invoice.

    Annual Registration Free: $25 per family is due before we are able to process this form.

    Do you accept the fees required for Before and After Care?

    Parent Signature:
    By typing your legal name into this form it is equal to your legal signature.

    Date: