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2015 Spring Benefit Childcare Registration

Quick Facts:

HOURS Friday, May 29, 2015 6:00-11:00 p.m.
Note: dinner will be served between 6:15-7:15.
PLACE Elementary School, 1212 S. Plymouth Court
PROVIDER Youth Guidance, School School’s Extended Day childcare provider
ELIGIBILITY Children of Spring Benefit attendees, ages 3 and up (must be potty trained).
Students do NOT need to be enrolled in the extended day program to participate.
COST $25/child, and $10 for each additional child in the same family.
A LA CARTE For students not currently enrolled in Extended Day, childcare from 3:30-6:00 p.m. can be arranged for an additional $25 per student.
Registration and Payment in Full are due by 12:00pm
Friday, May 29, 2015.

Participating students are expected to follow the School Way while at the school: “Be Safe, Be Responsible, Be Respectful.” Please leave electronic toys, Heely-type shoes, and valuables at home.
Parent/Guardian Name *
Please enter the parent/guardian name.
Email Address *
Please enter a valid email address.
Daytime Phone *
Please enter your daytime phone number.
Evening/Cell Phone *
Please enter your evening/cell phone number.
How to reach YOU during the event *
Please enter how to reach you during the event.
Alternate Emergency Contact Name *
Please enter an alternate emergency contact name.
Emergency Contact Phone *
Please enter an emergency contact phone number.
First Student Registration
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Student #1 Name *
Please enter the student's name.
Student #1 Age *
Please enter student #1's age.
Currently Enrolled in Extended Day? *
Please select yes or no.
Second Student Registration
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Quantity
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Student #2 Name
Please enter the student's name.
Student #2 Age
Please enter student #2's age.
Currently Enrolled in Extended Day?
Please select yes or no.
Third Student Registration
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Student #3 Name
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Student #3 Age
Please enter student #3's age.
Currently Enrolled in Extended Day?
Please select yes or no.
Fourth Student Registration
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Student #4 Name
Please enter the student's name.
Student #4 Age
Please enter student #4's age.
Currently Enrolled in Extended Day?
Please select yes or no.
A La Carte (3:30-6:00) Coverage
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Special Needs
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By selecting these check-boxes, you are indicating your agreement to the below-listed terms.
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