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ST. CATHERINE OF SIENNA SCHOOL
EXTENDED AFTER SCHOOL CARE MEDICAL FORM
20202021Childs Last NameFirst Rebirth DateAddressGradeCityZipTelephone NumberMother/GuardianCell phone #Work Phone Number Father/GuardianCell
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Extended care - st refers to the form that must be filled out and filed by individuals who provide care and support services to a qualified person with a disability or medical condition.
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Individuals who provide care and support services to a qualified person with a disability or medical condition are required to file extended care - st.
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The purpose of extended care - st is to report the care and support services provided to a qualified person with a disability or medical condition for tax purposes.
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Information such as the caregiver's name, address, and social security number, the qualified person's name and medical condition, and details about the care and support services provided must be reported on extended care - st.
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