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After-School Care Payment Form

Please complete the form below. Required fields marked with an asterisk *

If you have any issues with the form, please reach out to Kathy Demas or Autumn Jordan.

Student's Name*

Answer Required

Sibling's Name (If Applicable)

Answer Required

Parent's Name*

Answer Required

After-School Care Amount Paying*

You can chose the other option to pay for a full month, pay for one of the optional days, or if you have multiple children in the program for a pro-rated week.

Answer Required

$26.00 - Two-Day Week

$39.00 - Three-Day Week

$52.00 - Four-Day Week

$65.00 - Five-Day Week

$120.00 - Cost for two children in After-School Care Program for five-day week

Other:

You can add notes below (i.e. if you are paying for a full month at once, etc)

Answer Required

You can access the payment schedule by clicking here

Confirmation Email

Confirmation Email *

Email Required