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.

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?
---YesNo

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

Date: