Acton-Boxborough Regional School District Community Education 15 Charter Road, Acton, MA 01720 978-266-2525 fax: 978-266-2540 www.abce.abschools.org
DROP-IN REGISTRATION FORM 2016-2017 PLEASE REVIEW DROP-IN POLICY FAX T O: 978-266-2540 OR DELIVER TO THE COMM. ED. OFFICE 2 BUSINESS DAYS PRIOR TO NEEDING CARE. CONFIRMATION OF AVAILABLITY WILL BE EMAILED WITHIN 1 BUSINESS DAY OF RECEIPT OF REQUEST. Child’s Name(last, first)_________________________________
DOB_________ Gender: M / F
Home Address_________________________________________
Home Phone____________________
Check Program: Admin____;Gates____;Conant____ School attending: Conant__;Gates__;McT__;Merriam__;Douglas__;Blanchard__;
Grade:_________________________
Father/Guardian Name ___________________________
Mother/Guardian Name _______________________
Business Phone ________________________________
Business Phone _____________________________
Cell Phone_____________________________________
Cell Phone _________________________________
Email Address __________________________________
Email Address ______________________________
SCHEDULE Please: Check the box to indicate the day you wish to attend and enter the date, and check the time required.
½ Day Kindergarten Only
Grades K-6
Please Circle Extended Day required time: School hours PM Kin. School Hours $30.00
AM Only $15.00
Non Early Release Days PM Until 6pm $30.00
Early Release PM Until 6pm $65.00
Full Week – Dates_______________
$150.00
$75.00
Monday: Date_________________
$________
$________
$________
$________
Tuesday: Date ________________
$________
$________
$________
$________
Wednesday: Date _____________
$________
$________
$________
$________
Thursday: Date _______________
$________
$________
$________
$________
Friday: Date _________________
$________
$________
$________
$________
$25.
REGISTRATION FEE $30.00 per school year If Extended Day is able to accommodate my child, I understand and agree to the following:
All payment is due upon registration and is non-refundable should my child not attend or cancel, as there are limited Drop-In spaces available. Extended Day will return the tuition in the event there is not space available for my child . Confirmation has been received that there is space for my child. Transportation to the program in the morning and pick-up at the close of Extended Day is the responsibility of the parent. I will notify both the school and transportation. Extended Day Permissions have been completed online at the parent portal using the School District User ID and Password. Once registered subsequent requests should be made via email with 2 business days’ notice:
[email protected].
Parent Signature:_______________________________
Date: ____________________________