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Childcare Program Sign Up 2020-2021

Please complete the form below. Required fields marked with an asterisk *

I.D.C.S. Childcare

Extended Day

2020-2021

**NEW: Half Day Program

3/9/2021 and 3/11/ 2021

Childcare Program Coordinator: Monique Kercado, [email protected]

Please complete this form and send payment prior to the first day of childcare. Payments can be made online HERE, please contact Monique prior to making your first payment to confirm that you are in the system. All other payments should be in an envelope clearly marked with your child's name and "After School" and placed in the payment box near the main entrance. Checks should be made payable to IDCS.

Please reference the Childcare Webpage for more detailed program information, dates of operation, payment information, behavior expectations, and items to bring.

Student Information

Student First Name*

Answer Required

Student Last Name*

Answer Required

Please notate any allergies, medications or medical conditions that the staff should be aware of.

Answer Required

Parent Contact Information

First Name*

Answer Required

Last Name*

Answer Required

Email*

Answer Required

Best Phone # to reach you at between 3 p.m. and 4:30 p.m.*

Number Required

If your child will be picked up by someone other than yourself, please enter their name and phone number below.

Answer Required

Childcare Options

Half Day Program - $7.50/hour. Open Tuesday 3/9 and Thursday 3/11. Please sign up for which days you need care below.ion

Answer Required

Tuesday, 3/9

Thursday, 3/11

Extended Day - $7.50 /hour, Open Mondays-Tuesdays , Thursdays-Fridays from 3-6pm: Please sign up for which days you need care below.

Answer Required

Mondays

Tuesdays

Thursdays

Fridays

What time will you pick up by? (Latest pick up is at 6pm)

Answer Required

Terms of Acceptance and Signature

I, the parent/guardian, of the above named child, give the following permissions for my child to enroll in the After School Club Program.

I acknowledge that I have read the detailed program information, dates of operation, payment information, what to bring, late pick up regulations/fees, and behavior expectations on the IDCS Childcare Webpage. Please type your name for your electronic signature.*

Answer Required

I give permission for my child to receive emergency medical attention and/or be taken to the nearest hospital in the case of an emergency. Please type your first and last name for your electronic signature.*

Answer Required

I give permission for my child to use the internet during childcare programs under supervision. IDCS internet policy remains in effect. Please type your first and last name for electronic signature.

Answer Required

I understand and agree that registration fees will not be refunded if my child is withdrawn or dismissed for any reason. Please type your first and last name for your electronic signature.

Answer Required

Comments

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Confirmation Email

Email Required