CHILD(REN)'S NAME?SGRADE

GRADE

GRADE

PARENT/GUARDIAN'S NAME

ADDRESSCITY

HOME PHONEZIP CODE

OPTION SELECTED: Please indicate one of the following options

I- 7:00 - 8:05 a.m.

$ 100.00 per month

II- 2:30 - 4:00 p.m.

$ 125.00 per month

III- 2:30 - 5:00 p.m.

$150.00 per month

IV- 2:30 - 5:30 p.m.

$ 175.00 per month

V- 2:30 - 6:00 p.m.

$ 200.00 per month

Options I and II

$ 225.00 per month

Options I and III

$ 250.00 per month

Options I and IV

$275.00 per month

Options I and V

$300.00 per month

Drop-In

$9.00 per hour

.Fees are payable on a monthly basis and will be sent home on the first day of each month, ( if it falls on a school day, otherwise the following school day ). There is NO Lead on half days and days wheb school is not in session.

THERE WILL BE A LATE FEE OF $40.00 Per Child ANY TIME AFTER 6:00 PM.

NOTE: We require that parents arrange alternative child care plans in case of an emergency, severe weather, student illness, days when LEAD is not in session, etc. Due to increase problems experienced, we will exclude children from LEAD for seriously disruptive behavior, repeated failure of parents to pick up/keep sick children home, or repeated late pick up. Children are asked to bring a healthy snack and a book to read daily.

A non-refundable $10.00 registration free must accompany this application form.

I/We agree to abide by the school rules and regulations stipulated for the LEAD Program as described above.

Signature

Date

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