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Extended Daycare Registration Form

This document is a registration form for a 2015-2016 extended day care program at Saint Catherine of Siena Parish School in Laguna Beach, California. It requests information such as the student's name, grade, and birthdate as well as contact information for parents. It outlines the hourly and late pick-up fees. Billing will be done monthly with payment due by the first of each month, and credit card information can be provided for automatic payment if the balance is not paid by the 10th. By signing, parents agree to pay fees promptly and follow program rules.

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Sir Calaquei
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336 views1 page

Extended Daycare Registration Form

This document is a registration form for a 2015-2016 extended day care program at Saint Catherine of Siena Parish School in Laguna Beach, California. It requests information such as the student's name, grade, and birthdate as well as contact information for parents. It outlines the hourly and late pick-up fees. Billing will be done monthly with payment due by the first of each month, and credit card information can be provided for automatic payment if the balance is not paid by the 10th. By signing, parents agree to pay fees promptly and follow program rules.

Uploaded by

Sir Calaquei
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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30516 South Coast Highway

Laguna Beach, CA 92651


Phone: (949) 494-7339
FAX: (949) 376-5752
www.stcatherinelaguna.com

2015—2016 Extended Day Care Program Registration Form


Student’s Name/Grade in Sept./ Birth Date
1. ___________________________________________________________________________________________________________________________________________________

2. ____________________________________________________________________________________________________________________________________________________

3. _____________________________________________________________________________________________________________________________________________________

FAMILY INFORMATION:
Father/Guardian: ____________________________________________________ Mother/Guardian: ________________________________________________________
Address: ____________________________________________________ Address: ________________________________________________________
____________________________________________________ ________________________________________________________
Home Phone #: ____________________________________________________ Home Phone #: ________________________________________________________
Work Phone #: ____________________________________________________ Work Phone #: ________________________________________________________
Mobile Phone #: ____________________________________________________ Mobile Phone #: ________________________________________________________
Email: ____________________________________________________ Email: ________________________________________________________

Rates & Fees:


Hourly Rate is $10.00, billed in 15 minutes increments of $2.50. There is no charge for the first five (5) minutes.

Extended Care closes promptly at 6:00 p.m. A late pick up per minute charge of $1.00 per minute will be made for
each minute after 6:00 p.m.

Billing:
Weekly invoices will be provided by the 10th of the following month.

Payment:
Payment is due to the office by the first of each month. Check, cash or credit card is accepted. Balance not paid by
the 10th of each month will automatically be charged to your credit card along with a 3.5% handling fee.

Credit Card Information/Authorization:


Please complete this information, even if you choose to pay with a check or cash.
Name on card_______________________________________________________
Type of card: ____Visa ____MasterCard ____American Express
Credit Card Number:_________________________ Expiration Date:________

I/We the parents of ______________________________________________________________________ in consideration of acceptance into the Saint Cathe-
rine of Siena Parish School Extended Day Care Program, agree to make prompt payments of required fees and to adhere to all rules
and regulations of the program. We understand that our failure to meet the conditions of this agreement may result in our child’s be-
ing dismissed from the program.

__________________________________________________________________ ____________________________________________________________________
Father’/Guardian Signature Date Mother/Guardian Signature Date

FORMS/ Day Care Enrollment Form.pdf

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