Extended Care Program Registration Form

STATEMENT OF PURPOSE: The Extended Care Program exists to accommodate parents’ work hours by providing a supervised location to drop-off their children early in the morning, as well as a safe and enriching environment after school.

SCHEDULE: Morning Care is from 6:45-7:30 a.m. and After Care is from 3:30-6:00 p.m. on school days and is located in Building C.

SAFETY: For campus security and student accountability, all students who are on campus and are not participating in an extracurricular activity are required to sign in to After Care at 3:30 p.m. Students who participate in an extracurricular activity are given a grace period of 15 minutes to be picked up after the end of their activity. Students not picked up after the grace period are required to sign into After Care.

DAILY RATES: KHCS charges daily rates for use of the Extended Care program. Each child who signs into either Morning or After Care will be charged the following rates if they have not purchased a year pass:

• Morning Care daily rate: $0.33/minute per student

• After Care daily rate: $0.25/minute per student

YEAR PASS: Families with multiple children who regularly rely on the Extended Care program can save money by purchasing a Year Pass. The Year Pass is billed in 10 monthly installments. A $50 registration fee is required. Types and prices of year passes are listed below:

• Extended Care Year Pass (includes both Morning and After Care)
$3,000 for 1st student
Plus $750 for each additional sibling

• Morning Care Year Pass (Morning Care Only)
$1,250 for 1st student
Plus $750 for each additional sibling

• After Care Year Pass (After Care Only)
$2,500 for 1st student
Plus $750 for each additional sibling

Student #1 Name

Student #1 Grade

Student #2 Name

Student #2 Grade

Student #3 Name

Unnamed Label

Student #3 Grade

Student #4 Name

Student #4 Grade

Mother's Full Name

Father's Full Name

Parent Address

Parent Phone

Parent's Email

This address will receive a confirmation email

Select Program

Combined(Morning & After Care) Morning Care Only After Care Only

Registration Fee $50.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Submitting this form verifies that you have:
1. Read and understood the After Care Program Guidelines and Notice of Exemption.
2. Agree to support the After Care staff in their implementation of these policies.

CONTACT INFORMATION:
school@khcs.org
770-921-3224

Extended Care Program Registration Form

Description

Please Fix the Following