St. John’s After School Care Sign Up Form 

Please register and pay with this form by Thursday of the preceding week.

WEEKLY: Week of: ______________________________________

Family Name ______________________________________________

Child’s Name: __________________ Grade:________

	Monday	Tuesday	Wednesday	Thursday	Friday
1hr *2:15-3:30pm
2hrs 3:30-4:30pm
3hrs 4:30-5:30pm						Total Hours
Total Day Hours	+	+	+	+	=

*2:15-3:30 will be billed as one hour Total Week Hours x $2.50/hour: $______

OR  MONTHLY:  Month of: ______________________________

  Names: ____________________________________________

Please number each day and time that your child will be staying.

Monday	Tuesday Ex.    8 - 4:30	Wednesday  Ex. 9 - 4:30	Thursday  Ex. 10 - 4:30	Friday
					Total Hours

*2:15-3:30 will be billed as one hour Total Month Hours x $2.50/hour:  $________

(Office Use Only –  Scheduled ________ Receipt ________)  Date Paid ___________