Our Lady of Sorrows Regional School

EXTENDED DAY (AFTER SCHOOL CARE) PROGRAM

REGISTRATION FORM

 

YEAR  

GradeCHILD'S NAME

GradeCHILD'S NAME

GradeCHILD'S NAME

GradeCHILD'S NAME

GradeCHILD'S NAME

AddressCityStateZip

PARENT'S NAME Home Number

                                                                                                             Cell Phone Number

 

Registration Fee $10.00 per child
Daily Fees:  One Child $7.00
Two Children $13.00
Three or More Children $19.00
LATE FEES PER CHILD $5.00 PER FIVE MINUTES AFTER 6:00PM

Hours of Operation

Monday

2:35 pm - 6:00 pm

Tuesday -Friday

3:20 pm - 6:00 pm

 

I understand that in order to participate in the Extended Day Program, I will be

responsible for signing my child/children out and recording the departure time.

 

 

Signature and Date______________________________________________                                                                                                        

Print Form - Close Window