St. Elizabeth Catholic School

REGISTRATION FORM ~ EXTENDED SCHOOL

PROGRAM      2008-2009

I, ____________________________________, want to register my child/children for the Extended School Program for the 2008-2009 academic year.

                                                                Please circle which care you need:

___________________________________     Before Care      After Care        After Care

Student                                     Grade                                            (5 days)           (3 days)

___________________________________     Before Care      After Care        After Care

Student                                     Grade                                            (5 days)           (3 days) 

___________________________________     Before Care      After Care        After Care

Student                                     Grade                                            (5 days)           (3 days)

___________________________________     Before Care      After Care        After Care

Student                                     Grade                                            (5 days)           (3 days)

Enclosed, please find a check in the amount of $________________ ($50.00 per child) for a deposit for my child/children which is non-refundable.

If you choosing three days, which days would you be interested in?

________________________, ________________________, _____________________ 

Parent Signature                                                                                                Date

Received by __________________________________________

                     Name                                                      Date

Check number _________________                Amount  ______________________