Catholic of Pointe Coupee REGISTRATION PACKET Attached are new student registration documents. To register, complete the following documents and turn them in to the Principal s office. 1. Registration Form 2. Attach the registration fee to the registration form 3. Church Participation Form 4. Signed Covenant (PK3-6 th only) 5. Parent Service Hour Form (due 3/31/18) 6. Request for Records Form 7. School Transfer Form If transferring from another school within the Diocese of Baton Rouge. Please attach the following to your registration packet: 1. Copy of birth certificate 2. Copy of Social Security card 3. Immunization Records 4. Copy of most recent report card 5. Copy of most recent standardized tests 6. Copy of most recent discipline report One Family, One Vision in Christ The mission of Catholic of Pointe Coupee is to provide a religious, academic and disciplined Catholic education whereby students develop their talents in service to school, church, and society.
CATHOLIC OF POINTE COUPEE 405 LOUISIANA ST. NEW ROADS, LA 70760 (225) 638-9313 FAX (225) 638-3563 February 1, 2017 We are excited to announce the registration dates for the 2017-2018 school term: 2017/2018 Registration: February 1 st February 24 th To register for 2017/2018, complete the following: 1. Enclosed is a Registration Form for all current students. Please correct/update this Registration Form for each returning student. This form has emergency, email and contact information that is updated each year and kept on file in the Elementary and High School offices. 2. If you have a new student to enroll, registration forms can be found online at www.catholicpc.com. 3. Return the enclosed Registration Form(s) with $200 registration fee, per student, to the Business Office before 3:00 pm on Friday, February 24 th. Registration fees increase to $250 per student on or after Saturday, February 25 th. Registration fees increase to $300 per student on or after Monday, May 1 st. 4. A student will not be considered for registration until the enclosed 2017-2018 Registration Form and registration fee have been received by the Business Office, and all past due financial balances, including aftercare, have been paid. 5. The School Board sets limits and caps for classroom sizes. Because of these caps, new applications are not a guarantee for admission. Notification of acceptances will be made by the Elementary Office and the High School Office. TUITION AND FEES POLICY In keeping with many other schools in the Diocese, Catholic School of Pointe Coupee requires prepaid tuition. This practice allows all collected money to draw interest, which in turn benefits the school financially. Tuition and fees must be paid in full by Thursday, June 1, 2017. No student will be allowed to begin school in August 2017 until tuition and fees have been paid in full or tuition loans are current with no past due balance. School Tuition Loans will be available through Gulf Coast Bank & Trust Company. We have secured an interest rate of 8.00% for the 2017-2018 school year. The principal and interest are payable in ten monthly payments beginning July 1, 2017. Parents interested in taking out loans to pay for tuition and fees (excluding registration fees) can access information on the school s website (catholicpc.com) in March on how to complete an application online. Loans are not available to those who have had a loan default and charge-back in the past. Over
Please review the following policies implemented by the School Board for 2017/2018: Registration Fees will increase to $250 per student for those registering on or after 2/25/17. Registration Fees will increase to $300 per student for those registering on or after 5/1/17. A late fee of $100 will be charged to those paying tuition or taking out a loan on or after 6/2/17. Tuition and Fee Schedule for 2017/2018 Payable by February 24 th : Registration : $200.00 per student (non-refundable - fourth student is free) Registration fees increase to $250 per student on February 25, 2017. Registration fees increase to $300 per student on May 1, 2017. ------------------------------------------------------------------------------------------------------------------------------- Payable by June 1, 2017: Tuition: Elementary - $4,445 per student (3 yr. old - 6 th grade) - $3,335 per student (3 yr. old 3 days only) High School - $5,415 per student (7 th - 12 th grade) Family Max - Fourth student is free - applies to the youngest student enrolled. Supply Fee $75 per student (HH3 thru 3 rd grade ONLY) Instructional Fee $150 Bldg/Maintenance $200 per student per family Graduation Fee $260 (Seniors Only for senior retreat and graduation expenses) Security Fee $20 per student Technology Fee $100 per student HH3 8 th grade $150 per student 9 th 12 th grade Activity Fee $150 per student 7 th - 12 th grade Yearbook Fee $60 (OPTIONAL - must return enclosed insert) Late Fee: $100 late fee will be charged for those paying tuition or taking out a loan on or after June 2, 2017. **Please do not pay tuition at this time. Once registration is complete you will receive an itemized invoice in the mail.**
Admission Guidelines Criteria for Acceptance Students will be accepted into Catholic of Pointe Coupee according to the following priorities: 1. All students presently in attendance and in good standing (i.e. financial behavioral, academic). 2. New students from families now in attendance; this is for first-time attending students only. 3. New students from CISPC alumni families (legal parent or guardian). Legal parent is the person who claims the child as a dependent on income tax forms. Family is defined as those persons appearing on income tax form as dependents. 4. New Catholic students from the area, with letter from local pastor, and Catholic students who previously attended CISPC and have paid a readmission fee. 5. New non-catholic students. Note: In determining acceptance, the school will review the academic, discipline, and attendance records of students transferring from another school.
Catholic Interparochial School of Pointe Coupee 405 Louisiana Street New Roads, LA 70760 (225)638-9313 New Family Current Family Date: Entering Grade: HH3 Program 3day/week Student s Name (Last) (First) (Middle) MAILING ADDRESS: Street Male Female City Birth Date State Zip Birth Place Home Phone U.S. Citizen Yes No Student s cell phone # Student s Social Security # Church Presently Attending Religion Baptism Date Communion Date Confirmation Date FAMILY INFORMATION Father/Guardian Name Deceased: Yes No Address City State Zip Occupation Employer Home Phone # Work Phone # Cell Phone E-mail address CISPC Alumni: Yes No Year Father s Religion Mother/Guardian (include Maiden name) Name Deceased: Yes No Address City State Occupation Employer Home Phone # Work Phone # Cell Phone E-mail address CISPC Alumni: Yes No Year Mother s Religion Parents separated? Yes No Double mailing requested Yes No Legal guardian (relationship) Party responsible for fees Emergency Information if you can t be reached: Name(s) Relationship Phone Number 1
LIST ALL SCHOOLS STUDENT ATTENDED FROM K THROUGH PRESENT: Year Grade School & Location (including mailing address) Extra-Curricular School/Parish Activities: List student s brothers and sisters: Name School Attending/Attended Grade/Year of Graduation Age Has student ever been DISMISSED from school for any reason? Yes No Asked to withdraw? Received severe disciplinary censure? If Yes to any of these questions, attach details including name of school and year. Will this be the oldest (or only) child attending? Yes No Nearest public school to applicant s home: HEALTH FORM Has student been absent more than five (5) days during the most recent school term? If so, please explain further: Allergies: List any serious or chronic illnesses or medical conditions: Does student take any medication routinely? If so, what? Does student have special needs (medical or academic)? If so, please explain further: PLEASE ATTACH THE FOLLOWING: Xerox copy of the latest report card Copy of Baptismal Certificate Standardized test scores Pastor approval letter Birth certificate Updated health card Copy of Social Security Card Failure to provide all requested information may result in student not being considered for admission. Registration fee will be refunded only upon denial of admission. Date Parent s Signature The admission policy of the school prohibits discrimination in accordance with the Title IX of the Civil Rights Act of 1964. 2
Catholic of Pointe Coupee School Church Parish Participation & Verification Form DIRECTIONS: Please give thought and reflection to your responses and attach additional pages if needed. Deliver completed form, either by mail or in person, to your pastor. He will sign and return to the school. Student s Name Student s Father Father s Religion Attended Catholic School? Where & when graduated? Occupation Place of Business Work phone Home phone Church Parish Registered in? Student Information: Baptized Catholic? Grade for upcoming year? Student s Mother Mother s Religion Attended Catholic School? Where & when graduated? Occupation Place of Business Work phone Home phone Church Parish Registered in? Where baptized? Previous School attended Questionnaire: 1. Participation at Sunday Mass: Do you and your children attend Mass (a) Faithfully (b) Usually (c) Occasionally (d) Seldom (e) Never. Circle one and explain. 2. Are you an identified offertory contributor in your parish? Do you use the church envelopes? 3. As Catholic parents, please describe your support and participation in the ministries/life of your church (lector, Eucharistic Minister, religious education, church maintenance, music, etc.) Over
4. Parents are the primary religious educators of their children. Describe the faith life of your family at home that supports your child s faith development. 5. Please tell why you wish to enroll your child at Catholic of Pointe Coupee School. 6. If your child attended public school, please describe their participation in religious education. -------------------------------------------- Do Not Write Below this Line --------------------------------------------- Pastoral Review ( ) I can confirm this family s participation in our church community. ( ) I cannot confirm this family s participation in our church community. ( ) I recommend that this family be required to obtain parish verification next year in order to register for Catholic of Pointe Coupee School. Pastor s Signature Date Name of Parish Comments: Pastors: Please mail to Catholic of Pointe Coupee, 304 Napoleon St. (Elementary) or 504 4 th Street (HS), New Roads, LA 70760.
CATHOLIC INTERPAROCHIAL SCHOOL OF POINTE COUPEE COVENANT Catholic of Pointe Coupee call administrators, teachers and parents to acknowledge that the spiritual formation of our children is the primary responsibility of the parent. The Catholic School assists and reinforces that formation. We understand that it is the stated mission of Catholic of Pointe Coupee to provide an environment which contributes to the formation of their Catholic identity, by providing a foundation for a life of prayer, knowledge and service. In order to achieve the greatest harmony between home and school in passing on our faith, and meeting the challenges of Catholic living we make a conscious commitment to the following practices: For Catholic Families: We pledge to instill in our children the values of Jesus Christ through regular Mass attendance, participation in the life of the Church, and development of a substantive family prayer life. We pledge to support St. Mary s Catholic Church or our home Catholic Church parish and its ministries through contributions of time, talent and offering. We pledge through prayer and lifestyle, to uphold and support the Roman Catholic Church, its teachings and its doctrines. For Non-Catholic Families: We pledge to instill in our children the values of Jesus Christ through regular church attendance, participation in religious rites and practices, and development of a substantive family prayer life. We pledge support to our chosen church, synagogue, or temple and its ministries through contributions of time, talent, and offering. We pledge through prayer and lifestyle, to uphold the philosophy which governs Catholic of Pointe Coupee School. Signature of Parent/Guardian Print Name Date
Parent Service Hour Program Guidelines. 1. Fifteen (15) service hours are required per family per school year. 2. Service hours are any that directly benefit Catholic of Pointe Coupee. 3. If a family chooses not to participate, there will be a financial obligation of $500 due and payable together with tuition for the upcoming academic school year. Parent Service Hour Forms are due on March 31 st of each year. If we do not receive your completed parent service hour form by March 31, 2018 and/or less than 15 hours of service are performed you will be billed for the unperformed service hours. NO EXCEPTIONS! 4. Service hours may be completed by any non-student family member or designee. Students cannot perform parent service hours. 5. The service hour program runs from April 1 March 31 st. Parents can earn service hours for the 2017/2018 school year from April 1, 2017 March 31, 2018. 6. Service hours may not be sold, transferred, or carried over to the following year. 7. Service Hours will only be counted if submitted on the approved Service Hour Form via fax (638-3563), email (rkellerman@catholicpc.com), mail or hand delivered to the Business Office (405 Louisiana St., New Roads) or sent to school with your child. The form is on the website under Parents/Parent Responsibilities. Please keep a copy for your own records. If you send your form with your student, please know there is a risk that it may not reach the office. Please note that sign-in sheets do not replace Parent Service Hour Forms. 8. EXEMPTION: Due to the large number of volunteer hours worked by those serving in the following roles, they will not be required to list all Service Hours but must complete the Exemption section of the Service Hour Form and submit to the Business Office before March 31 st. (Exemptions apply to: School Board members, Home & School President and VP, Green Hornet Club President and VP, volunteer athletic coaches) 9. If a family performs more than 15 hours in a given school year, your name will be placed in a drawing for discounted tuition for the following school year. **NEW** You will be awarded an additional entry into the drawing for hours worked in excess of the minimum required hours. For example, if you turn in the following number of APPROVED hours, you will receive the following number of entries into the drawing: 15 hours no entry into drawing 16-20 hours 1 entry 21-25 hours 2 entries 26-30 hours 3 entries 31-35 hours 4 entries, etc. 10. Service opportunities can be found on the website under Parents > Parent Responsibilities. Additional Rules and Regulations: *NEW* Chaperoning Elementary field trips does not count toward your service hour requirement. The only field trips that count toward service hours are the 7 th /8 th grade Washington/New York and Beta Club Convention. These approved field trips have a MAXIMUM OF 10 HOURS that can count toward Parent Service Hours. In addition, only one family member may receive service hours for these particular field trips. Transporting your student to and from school activities will not count toward Parent Service Hours unless you have been asked by the school to be an official driver for students to a particular event.
Parent Service Hours (Deadline 3/31) Family receiving credit for service hours Name: Address: School Yr: 20 /20 Students: Date Activity Hours School Personnel Adult Performing Worked In Charge the Service Hours Notes: Exempt from service hours? Reason: School Administration Signature * Submit via fax 225-638-3563, email rkellerman@catholicpc.com, mail (405 Louisiana St., New Roads) or hand deliver to Business Office. One Family, One Vision in Christ
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS OFFICE OF PUBLIC HEALTH IMMUNIZATION SCHEDULE 2015 through 2016 Depending on the child's age, choose the appropriate initial set of immunizations. RECOMMENDED SCHEDULE FOR IMMUNIZATION OF INFANTS AND CHILDREN ACCELERATED SCHEDULE FOR CHILDREN STARTING IMMUNIZATIONS LATE AGE Birth HBV 2 Months DTaP, Hib, IPV, HBV, PCV, RV 4 Months DTaP, Hib, IPV,PCV, RV 6 Months DTaP, Hib, IPV, HBV, PCV, Flu, RV 12-15 Months DTaP, Hib, MMR, Var, PCV, HAV 18-23 Months HAV 4 Years Of Age DTaP, IPV, MMR, Var Or Prior To School Entry 11-12 Years Tdap, MCV4, HPV (VAR, MMR, HBV If needed) 16 year MCV4 CHILDREN 4 MONTHS TO 7 YEARS OF AGE 1st Visit 2nd Visit (4 wks. after the 1st visit) 3rd Visit (4 wks. after the 2nd visit) 4th Visit (6 mos. after the 3rd visit) DTaP, Hib*,IPV,MMR,HBV,HAV, Var, Flu, PCV DTaP, Hib, HBV, IPV, PCV, Flu DTaP, Hib, PCV DTaP, Hib, HBV, IPV, PCV,HAV 4 Years Of Age DTaP, IPV, MMR (Var if needed) Or Prior To School Entry 11-12 Years Tdap, MCV4, HPV (Var, MMR, HBV if needed) 16 Years MCV4 CHILDREN 7-18 YEARS OF AGE 1st Visit 2nd Visit (4 wks. after the 1st visit) 3rd Visit (6 mos. after the 2nd visit) Td, IPV, HBV, MMR, Var Td, IPV, HBV, MMR Td, IPV, HBV 11-12 Years Tdap, MCV4, HPV (Var, MMR,HBV,IPV if needed) 16 Years MCV4 VACCINE ABBREVIATIONS HBV HEPATITIS B VACCINE, HAV HEPATITIS A VACCINE, DTaP DIPHTHERIA - TETANUS - ACELLULAR PERTUSSIS VACCINE, Hib HAEMOPHILUS INFLUENZA TYPE B VACCINE, Td ADULT TYPE TETANUS AND DIPHTHERIA VACCINE, Tdap TETANUS AND DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE, IPV INACTIVATED POLIOVIRUS VACCINE, RV ROTAVIRUS VACCINE, FLU INFLUENZA VACCINE, MCV4 MENINGOCOCCAL CONJUGATE VACCINE, HPV HUMAN PAPILLOMAVIRUS VACCINE MMR MEASLES - MUMPS - RUBELLA VACCINE, VAR VARICELLA VACCINE, PCV PNEUMOCOCCAL CONJUGATE VACCINE. THE SCHEDULE ABOVE AND THE FOLLOWING GUIDELINES ARE SUMMARIES, FOR MORE DETAILED INFORMATION ON EACH VACCINE, REFER TO THE MANUFACTURERS PRODUCT INSERT OR VIST THE NATIONAL IMMUNIZATION PROGRAM WEB SITE AT WWW.CDC.GOV/VACCINES OR CALL THE NATIONAL IMMUNIZATION HOTLINE AT 800-232-2522 (ENGLISH) OR 800-232-0233 (SPANISH).
HBV - Unimmunized infants should be given a first dose of Thimerosal-free HBV when first encountered, a second dose a minimum of 1 month later, and a third dose a minimum of 4 months after the first. Children aged 11 through 18 years of age who have not previously received 3 doses of Hepatitis B vaccine should be vaccinated. The 2 nd dose should be administered at least 1 month after the 1 st dose, and the 3 rd dose should be administered at least 4 months after the 1 st dose and at least 2 mos. after the 2 nd dose. The minimum age for dose #3 is 6 months. Hepatitis B vaccine is routinely recommended for all children up to 19 years of age. HAV Routine Hepatitis A vaccination is recommended for all children 12 months through 18 years of age. The two doses in the series should be administered at least 6 months apart. DTaP - DTaP vaccine is recommended and can be administered any time after 6 weeks of age. The 4 th dose of DTaP vaccine should be given at least 6 months after the 3 rd dose. Pediatric DT (Diphtheria-Tetanus) should be substituted for DTaP when Pertussis vaccine is contraindicated. Persons aged 7 and older who are fully immunized with DtaP should receive a Tdap at 11-12 years in place of Td booster. Persons aged 7 years and older who are not fully immunized with DTaP vaccine should receive Tdap vaccine as 1 (preferably the first) dose in the catch-up series; if additional doses are needed, use Td vaccine. For children 7 through 10 years who receive a dose of Tdap as part of the catch-up series, an adolescent Tdap vaccine dose at age 11 through 12 years should NOT be administered. Td should be administered instead 10 years after the Tdap dose. Adolescents 13-18 years who missed the 11-12 year Td/Tdap booster should also receive a single dose of Tdap if they completed the recommended childhood DTaP series. No minimum interval required between giving doses of Td and Tdap. Subsequent routine Td boosters are recommended every 10 years. Hib - Hib vaccine can be administered any time DTaP vaccine is given. If PRP-OMP (PedvaxHIB [Merck]) is administered at 2 and 4 mos. of age, a dose at 6 mos. is not required. Children who are 7 months of age or older at the time they receive the 1 st Hib vaccination should be immunized as follows: 1) Unimmunized infants 7-11 months of age should receive a 3-dose regimen. A first dose should be given now, a second dose 1 month later, and a 3 rd dose after 12 months of age, at least 2 months after the previous dose. (2) Unimmunized children 12-13 months of age should receive a primary series of one dose and a booster at age 15 months. (3) Unimmunized children 15 months of age or older who have not yet reached their 5 th birthday should receive 1 dose. PCV - All children should receive a 3 dose primary series and a booster if vaccination begun at 6 mos. of age; a 2 dose primary series and a booster if vaccination is begun between 7 and 11 months of age; a 2 dose series and no booster if vaccination is begun between 12 and 23 months of age. If vaccination is initiated at 24 months of age, the child should receive 1 dose of PCV. Children 24 through 59 months of age should receive a single dose of PCV13. Children with underlying medical conditions, a single supplemental PCV13 is recommended following primary series. High risk or presumed high risk for pneumococcal disease should be immunized with Polysaccharide Vaccine (PPSV) depending on the number of doses of PCV that they have received. PCV vaccination is required as part of the Daycare/HeadStart Immunization Requirement for children less than 24 months of age. IPV - For infants, children and adolescents up to 18 years of age, the primary sequential series of IPV consists of four doses. The primary series is administered at 2 months, 4 months, 6-15 months and 4 years of age, or as age appropriate. A minimum of 6 month is required between the last two doses of IPV. RV - Administer the first dose between 6 and 14 weeks, 6days of age. Maximum age for any dose is 8 months. Minimum interval between doses is 4 weeks. Monavalent RV1 is administered at 2 and 4 mos. of age, and then a dose at 6 mos. is not required. Pentavalent RV5 is administered at 2 months, 4 months and 6 8 months. If RV brand is unknown a total of three (3) doses are needed. HPV - Administer the first dose of HPV vaccine between 11-12 years. Administer the second dose 2 months after the first dose and the third dose 6 months after the first dose. HPV catch up schedule: Four week minimum interval between dose 1and dose 2. A minimum interval of 12 weeks required between dose 2 and dose 3. The 3 rd dose should be given at least 24weeks after the 1 st dose. MMR - Two doses of MMR vaccine after 12 months of age are required with a minimum of 28 days separating them. If a child has received 2 doses of MMR vaccine after 12 months of age, another dose after the 4 th birthday is not necessary. Children 11-18 years of age not previously immunized with MMR should receive two doses. Individuals with one dose of MMR must receive an additional MMR Vaccination. Students in schools of higher learning must receive 2 doses of MMR prior to registration. MCV4 - Meningococcal conjugate vaccine should be administered to all children at age 11-12 years, a booster dose on/after 16 years. The minimum interval between doses of MCV vaccine is 8 weeks. Var - All susceptible children who are at least 12 months old through 18 years of age are eligible. Administer the second dose of Varicella at age 4 6 years. Varicella Vaccine may be administered prior to 4-6 years, provided that 3 months have elapsed since the first dose and both doses are administered at 12 months. Susceptible persons aged 12 years should receive two doses at least 1 month apart. Parental history of having had chickenpox is acceptable. Physician documentation is not necessary at this time. Flu - Routine annual influenza vaccination is recommended for all children 6 mos 18 years. Two doses administered at least 1 month apart are recommended for children aged 6 mos 8 yrs who are receiving the influenza vaccine for the 1 st time, as well as, those who only received 1 dose in their previous year of vaccination, if applicable. DTaP, IPV, HBV, PCV, RV and Hib can be administered as early as 6 weeks of age and simultaneously. LOUISIANA STATE LAW requires prior to school entry: 2 doses of MMR, 3 Hepatitis B, 2 Varicella and booster doses of DTaP and Polio vaccines on or after the 4 th birthday and prior to school entry. A preschool dose is not necessary if the 4 th dose of DTaP and the 3 rd dose of IPV (provided it is administered at least 6 months after dose 2) are administered after the 4 th birthday. Sixth graders (11-12 years of age) are required: 1 Tdap, 2 VAR, 2MMR, 3 HBV, 1 MCV. Depending on the child s age, choose the appropriate initial set of immunizations. Sometimes a scheduled dose of vaccine may not be given on time. If this occurs, the dose should be given at the next visit. It is not necessary to restart the series of any vaccine due to extended intervals between doses. see Hib section see HPV section see PCV section Adolescents and post adolescents (11-18 yrs.) should be vaccinated with a second dose of MMR, Varicella (if no history of disease) and Hepatitis B if no history of previous vaccination. Four Day Grace Period: All vaccine doses administered less than or equal to four days before the required minimum interval or age shall be considered valid doses when evaluating a student record for compliance with immunization requirements for schools and child care entry. The Advisory Committee on Immunization Practices (ACIP) continues to recommend that vaccine doses not be given at intervals less than the minimum intervals or earlier than the minimum age.
Catholic of Pointe Coupee Extended Day Program Hours of Operation: Before Care 7:00 am to 7:35 am (Drop off in old business office T- Building located between high school parking lot and cafeteria.) After Care 3:00 pm to 6:00 pm. Late fees will be assessed after 6:00 pm. Days of Operation: Before-care and after-care are available on all school days, including half days. Ages: Students in HH3 through 6 th grade. Fees: Registration - $25.00 per student for either before or after care. Non- refundable due the first day of school along with the attached registration form. Fee Schedule Students must be registered in order to attend either program. Morning care no charge (Registration fee must be paid) After Care - $10.00/day per child Continued on back:
Late Fees: A late fee of $1/minute per child will be assessed if students are picked up after 6:00 pm Payment Due Date: Invoices will be emailed to the email address on file at the beginning of each month (for the previous month s charges) by the business office and are due by the last day of the month in which you receive your invoice. For example, if you receive an invoice on September 5 th, your payment is due no later than September 30 th. A $15.00 late fee will be assessed on past due accounts. Billing statements will be emailed and will not be sent home in students booksacks. It is YOUR responsibility to ensure your correct email address is on file in the business office. Please make checks payable to Catholic of Pointe Coupee and put morning care or after care in the memo for the registration fee and monthly payment.
Catholic of Pointe Coupee Aftercare Program Registration Form Student Name Grade Teacher ************************************************************************************** Student Home Address: Mother Home Phone Work # Cell # Father Home Phone Work # Cell # Special Needs: Please list any special needs (i.e. allergies, medical conditions) Emergency Contacts: In the event neither parent can be reached. Name Relationship Home Phone Cell # Name Relationship Home Phone Cell # When picking up your child, a sign out sheet is provided that MUST be signed before leaving. Only parents and those listed on the Approved Sign-Out List" on the back of this form will be allowed to pick up students. Continued on back:
APPROVED AFTERCARE SIGN-OUT LIST Please list below anyone approved to pick up your child/children in the event you are unable to do so. If you know in advance that you are sending someone on this list to pick up your child, please send a note to school to the attention of aftercare. Student(s) Name NAME Relationship Ph. # NAME Relationship Ph. # NAME Relationship Ph. # NAME Relationship Ph. # NAME Relationship Ph. # ************************************************************************************** Parent or Guardian Approval Signature: Date: ***This form is due the first day of school with the Registration Fee of $25/student. Please bring to the Elementary Office.***