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EXTENDED DAY ENROLLMENT FORM 201516 Grade Enrollment Date (if not the first day of school) A.M. 7:008:20 P.M. 3:006:00 W/D Date NAME D.O.B. AGE SEX ADDRESS ZIP CODE MOM IS NAME ADDRESS Home # CELL
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How to fill out an extended day enrollment form:

01
Start by reviewing the form instructions: Familiarize yourself with the purpose of the extended day enrollment form and any specific guidelines mentioned. Make sure you understand what information needs to be provided.
02
Personal Information: Fill in your personal details such as your name, address, contact number, and email address. Double-check for accuracy to ensure that you can be reached easily if needed.
03
Student Information: Provide essential details about the student for whom the extended day enrollment is being requested. This may include their full name, grade level, school, and any specific needs or requirements they may have.
04
Emergency Contacts: Include the names, phone numbers, and relationships of at least two individuals who can be contacted in case of an emergency when the student is in the extended day program. Make sure these individuals are aware of their role and are willing to be contacted if necessary.
05
Medical Information: Indicate any relevant medical conditions or allergies the student may have. If applicable, provide details about any medication the student needs to take during the extended day program and instructions on administration.
06
Authorized Pick-up: Specify the individuals authorized to pick up the student from the extended day program. Include their names and contact information to ensure a smooth process at the end of each session. This is an important safety measure to ensure the student is released only to authorized individuals.
07
Signature and Date: Once you have completed filling out the form, sign and date it to verify the accuracy of the information provided. Make sure to read and understand any waivers, policies, or terms mentioned on the form before signing.

Who needs an extended day enrollment form?

Extended day enrollment forms are typically required for students who will be participating in after-school programs, before-school programs, or any other additional care or activities held outside regular school hours. These forms may be required by schools, organizations, or clubs offering extended day services to ensure the safety, well-being, and appropriate supervision of the students. Parents or guardians of the students are usually responsible for filling out and submitting the extended day enrollment form.
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The extended day enrollment form is a document that parents or guardians fill out to enroll their child in before or after school programs that extend beyond regular school hours.
Parents or guardians of students who wish to participate in extended day programs are required to file the enrollment form.
The extended day enrollment form typically requires basic information about the student, emergency contact information, any medical conditions or allergies, and the desired schedule for the extended day program.
The purpose of the extended day enrollment form is to gather necessary information to ensure the safety and well-being of students participating in before and after school programs.
Information such as student's name, age, grade, emergency contacts, medical conditions, allergies, and desired schedule for the extended day program must be reported on the form.
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