Before and After Care Form


During the care periods the children will be under strict supervision. 

Snacks will be provided. There is no after care available on Fridays. 

You can sign up on a week to week basis.


 Childs Last Name

 Childs First Name




Before care

8:00 am—9:00 am
 
$5 a day per child

Week 1    Mon   Tue  Wed  Thu   Fri
 
Week 2    Mon   Tue  Wed  Thu  Fri

Week 3    Mon   Tue  Wed  Thu  Fri

Week 4    Mon   Tue  Wed  Thu  Fri

Week 5    Mon   Tue  Wed  Thu  Fri

Week 6    Mon   Tue  Wed  Thu  Fri

Week 7    Mon   Tue  Wed  Thu  Fri

Week 8    Mon   Tue  Wed  Thu  Fri 




After care


3:30 pm—5:30 pm

$8 a day per child (hourly option available)

Week 1    Mon   Tue  Wed  Thu   
 
Week 2    Mon   Tue  Wed  Thu 

Week 3    Mon   Tue  Wed  Thu 

Week 4    Mon   Tue  Wed  Thu 

Week 5    Mon   Tue  Wed  Thu 

Week 6    Mon   Tue  Wed  Thu

Week 7    Mon   Tue  Wed  Thu 

Week 8    Mon   Tue  Wed  Thu  


Total before care days

Total after care days

Payment
 
 
       
           

 

 

I will be paying by:    Amex  Mastercard    Visa    Discover

 Total amount 

 Card Number 
  
   Expiration Date  

 First Name on card   

 Last Name on card   

CVV Security Code  What's This? 

 

I will be sending in a check 

If you have any questions please call our office at 856-874-1500 or
type in box below.