After-School Care and Tutoring Services Contract Form
Complete this form to enroll a child in after-school care and tutoring services and provide the schedule, pickup, contact, and billing details needed to set up the contract.
Child and Guardian Information
Child's Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade Level
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Primary Guardian Full Name
*
First Name
Middle Name
Last Name
Service Schedule and Pickup Details
Attendance Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Days of Attendance
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Expected Pickup Time
*
Hour Minutes
AM
PM
AM/PM Option
Authorized Pickup Notes / Instructions
Contact and Billing Information
Best Parent/Guardian Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Billing Preference
*
Please Select
Invoice by Email
Monthly Statement
Pay at Drop-Off
Other
Submit Contract
Should be Empty: