After-School Care Registration

Required

Parent Namerequired

First Name

Last Name

Email Addressrequired

Phonerequired

How many students will be in After School Care?required

Student Namerequired

First Name

Last Name

Current Graderequired

Student 2 Namerequired

First Name

Last Name

Student 2 Current Grade

Student 3 Namerequired

First Name

Last Name

Student 3 Current Grade

Student 4 Namerequired

First Name

Last Name

Student 4 Current Grade

We plan to use After-School Carerequired

Regularly

Occasionally

Which days will your child(ren) require After School Care?Please select up to 5 choices

Please select up to 5 choices

Approximately what time do you anticipate picking up your children?required

LCCS currently has emergency contacts, people authorized to pick-up your children, and medical/allergy information on file. Is there any other specific information we need to know regarding your child's participation in after-school care?

Signaturerequired

I have read and understand the After-School Care Expectations and Procedures.

LCCS Families

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After-School Care Registration