Extended Care Registration 24-25

Registration Form 2024-2025

In the event of an emergency, or your child becomes ill at Extended Care, it is imperative we have up to date information so that you can be notified and arrangements can be made. You will be called first, and only if you cannot be reached will other steps be taken.

Student Information

Please register each student individually.

Last Name: *

Answer Required

First Name: *

Answer Required

Grade Entering 2024-2025*

Answer Required

Home Address*

Answer Required

Allergies, Medical, or Special Needs

Answer Required

Parent 1 / Guardian Information

Last Name:*

Answer Required

First Name: *

Answer Required

Email Address*

Answer Required

Phone Number*

Number Required

Alternate Phone Number

Number Required

Parent 2 / Guardian Information

Full Name

Answer Required

Email Address

Answer Required

Phone Number

Number Required

Alternate Phone Number

Number Required

Authorizations

Additional people who may pick up your child:*

Answer Required

I hereby give permission for my child to receive the following at Extended Care when necessary:*

Answer Required

Benadryl

Ibuprofen

Tylenol

Family provided medicine with instructions

None

The staff of Assumption-St. Bridget's Extended Care will take the steps indicated in case of injury or illness to my child.*

Answer Required

I hereby authorize

Emergency Contacts

Used in case you cannot be reached. These contacts may also be called if Extended Care is closed and a parent/guardian has yet to pick up your child(ren).

Emergency Contact 1 Full Name*

Answer Required

Emergency Contact 1 Phone Number *

Number Required

Emergency Contact 2 Full Name*

Answer Required

Emergency Contact 2 Phone Number *

Number Required

Rates & Billing Information

Extended Care is a prepayment, preregistration program. To ensure that consistent childcare will be available, families will need to choose one of three prepayment options to be added to their tuition payment plan. For detailed information on the payment breakdown please visit the ASB School Extended Care webpage, and click on the Extended Care Rates information sheet.

1/4 time (1-6 hours a week) $2600/year or $260 a month when added to a 10 month tuition payment plan.
1/2 time (7-12 hours a week) $3880/year or $388 a month when added to a10 month tuition payment plan.
Full Time (13-24 hours a week) $5800/year or $580 a month when added to a10 month tuition payment plan.

Drop-in use of Extended Care is only available on an extremely limited basis. Drop-in Extended Care exists to accommodate families with minor emergencies, unavoidable conflicts or the very occasional need. Drop-in Extended Care is billed at $25 an hour.

Please indicate which prepayment option you are selecting for Extended Care 2024-2025. Charges for Extended Care will be added to FACTS as a part of the tuition payment plan.*

Answer Required

1/4 time (1-6 hours a week) $2600/year or $260/month when added to a 10 month tuition payment plan.

1/2 time (7-12 hours a week) $3880/year or $388/month when added to a 10 month tuition payment plan.

Full Time (13-24 hours a week) $5800/year or $580/month when added to a 10 month tuition payment plan

Drop-in use at $25/hour. Drop-in use of Extended Care is only available on a limited basis.

Please check this box, if you intend to share the plan selected between multiple children.

Parent/Guardian Signature: *

Answer Required

Please fix the highlighted areas below before submitting.

Extended Care Registration 24-25

Registration Form 2024-2025