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/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/hour:       $________

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