After School Care Registration Form

2023-2024 School Year

Family Last Name*
Last
After School Care Start Date*
MM slash DD slash YYYY
Please check the box ONLY if you intend to use ASC on an as needed basis.
Please remember: Reservations and payment should be made by Thursday of the week before care is needed.
- We plan to use ASC on an as-needed basis.
Student Information*
Use the (+) symbol to add multiple names. Please indicate the days that each student will regularly attend ASC. You may type the following abbreviations in the box: M - Monday, T - Tuesday, W - Wednesday, H - Thursday, F - Friday.
Name Grade Days attending Approx. Pick-Up Time
Please list any of your child(ren)'s special needs.
This may include details related to allergies, custody arrangements, etc.
Approved Pick Up List*
Please provide the names of all people (PARENTS INCLUDED) who may pick up this child/these children from After School Care. Use the (+) symbol to add multiple names.
Name Relationship Cell Phone Number
Consent*
I consent to the After School Care Program guidelines and give permission for any adult listed above to pick up my child/children from the St. Ignatius After School Care Program.

Name	Grade	Days attending	Approx. Pick-Up Time

Name	Relationship	Cell Phone Number