Bright Ideas Learning Community LLC

4K After Care Registration Form

Please complete and return this form with the $35 enrollment fee to reserve a spot for Fall 2015. You will receive an email confirmation once the center as received your information. Please contact Traci with any questions. We look forward to working with you!

Child's Name _______________________________________ DOB ___/___/___

Parents' Names ______________________________________________________

Address ______________________________________________________________

City _______________________ Zip ________________

Phone # _________________________________

Alt. Phone # _____________________________

Email ________________________________________________________________

Please mark the days and times for which you would like to contract care.

Before Care 6:45-8:15 AM ($8.50 per day)

___ MON ___ TUE ___ WED ___ THU ___ FRI

4K After Care 11:15-3:45 PM (pick up by 3:15 on Thursdays) ($21 per day)

___ MON ___ TUE ___ WED ___ THU ___ FRI

Extended 4K After Care 11:15-6:00 PM ($34 per day)

___ MON ___ TUE ___ WED ___ THU ___ FRI

Spots will be reserved on a first come first served basis by returning this form to the center director with enrollment fee of $35 for new clients. Preference in availability is given to full time schedules. Please speak with the director if your schedule is less than 3 consistent days per week. Drop in care is an option based on availability.

By signing this form I agree that the above reflects the days I'd like to contract care for the 2015-2016 school year for my 4K child on regular school attendance days. Furthermore, I agree to abide by the Bright Ideas Learning Community, LLC policies as outlined in the policy manual. (A copy is available in the front hall for review.)

___________________________________________ ____________________

Parent Signature Date