Childcare Program Sign Up 2023-2024

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

I.D.C.S. Childcare

Extended Day

Half Day Program

Early Risers Program

2023-2024

Childcare Program Coordinator: Monique Kercado, [email protected]

Phone Number- 860-985-6922

Please complete this form prior to the first day of childcare. Payments must be made online by connecting your banking information or a debit/credit card in our payment system called Procare. Please contact Monique if you have any questions about payment. Cash and/or checks will no longer be accepted for child care payments.

Please reference the Childcare Webpage for more detailed program information, dates of operation, payment information, behavior expectations, and items to bring.

Student Information

Student First Name*

Answer Required

Student Last Name*

Answer Required

Please notate any allergies, medications or medical conditions that the staff should be aware of.

Answer Required

Parent Contact Information

First Name*

Answer Required

Last Name*

Answer Required

Email*

Answer Required

Best Phone # to reach you at between 3 p.m. and 4:30 p.m.*

Number Required

If your child will be picked up by someone other than yourself, please enter their name and phone number below.

Answer Required

Childcare Options

Extended Day - $7.50 /hour, Open Mondays-Fridays, from 3-6pm: Please sign up for which days you need care below.

Answer Required

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

What days will you need child care for the Early Risers Program? This program will start at 7am- 7:45am.

Answer Required

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

What time will you pick up by? (Latest pick up is at 6pm)

Answer Required

Terms of Acceptance and Signature

I, the parent/guardian, of the above named child, give the following permissions for my child to enroll in the After School Program.

I acknowledge that I have read the detailed program information, dates of operation, payment information, what to bring, late pick up regulations/fees, and behavior expectations on the IDCS Childcare Webpage. Please type your name for your electronic signature.*

Answer Required

I give permission for my child to receive emergency medical attention and/or be taken to the nearest hospital in the case of an emergency. Please type your first and last name for your electronic signature.*

Answer Required

I give permission for my child to use the internet during childcare programs under supervision. IDCS internet policy remains in effect. Please type your first and last name for electronic signature.

Answer Required

I understand and agree that registration fees will not be refunded if my child is withdrawn or dismissed for any reason. Please type your first and last name for your electronic signature.

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Comments

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Please fix the highlighted areas below before submitting.

Childcare Program Sign Up 2023-2024