Early Care Registration – Drop-in

Early Care for Grades 1-6:

Monday – Friday from 7:30 am-7:40 am

Drop-in rate: $6 per session

Monday – Friday from 7:00 am-7:40 am

Drop-in rate: $16 per session

Early Care for TK and Kindergarten:

Monday – Friday from 7:40 am-8:40 am

Drop-in rate: $18 per session

Monday – Friday from 7:00 am-8:40 am

Drop-in rate: $28 per session

No of Children
First Child's Name
First Last
First Child Grades Early Care
First Child Number of Days
First Child Date 1
MM slash DD slash YYYY
First Child Date 2
MM slash DD slash YYYY
First Child Date 3
MM slash DD slash YYYY
First Child Date 4
MM slash DD slash YYYY
First Child Date 5
MM slash DD slash YYYY
Second Child
Second Child's Name
First Last
Second Child Grades Early Care
Second Child Number of Days
Second Child Date 1
MM slash DD slash YYYY
Second Child Date 2
MM slash DD slash YYYY
Second Child Date 3
MM slash DD slash YYYY
Second Child Date 4
MM slash DD slash YYYY
Second Child Date 5
MM slash DD slash YYYY
Third Child
Third Child's Name
First Last
Third Child Grades Early Care
Third Child Number of Days
Third Child Date 1
MM slash DD slash YYYY
Third Child Date 2
MM slash DD slash YYYY
Third Child Date 3
MM slash DD slash YYYY
Third Child Date 4
MM slash DD slash YYYY
Third Child Date 5
MM slash DD slash YYYY
Your Purchase Information
Parent Name*
First Last
Parent Email*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Total
$0.00
Credit Card
Card Details
Cardholder Name
Phone
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