2023-24 Extended Day Registration Form

2023-24 Extended Day Registration Form

St. Anne-Pacelli Catholic School's Extended Day Enrichment Program is open to students in Pre-K3 through 8th grades. Early morning drop-off begins at 7:30 a.m. for no charge. After each day's school dismissal, the program is open from 3:30 p.m. until 6 p.m. The Extended Day Enrichment Program's daily schedule includes: snacks; homework time; indoor activities; and recess.

Extended Day Enrichment Program Rates:
Registration Fee: $40 per family
Monthly Charge: $165 per student*
Note: The month of December will be billed at $100
Daily Drop-In Charge: $17 per student

Note: Drop-in is only allotted 4 times a month. The daily fee is $17 for days 1-4. Any student exceeding four days will be charged $97 for day 5 and an additional $17 for days 6-31.

Update: Beginning November 1, 2023, we are changing the daily drop-in rate from $17 per drop-in to $6 per hour for student-athletes in grades 5-8 participating in an in-season sport. If an in-season student-athlete in grades 5-8 "drops in" to Extended Day more than four times in one month, his/her family will still only be charged $6 per hour for after-hours care.

*Sibling discounts for monthly attendees: $25 monthly discount for 2nd student and each additional student. Discount will not apply to December.

Your student's Extended Day fees will be invoiced via FACTS.

Please complete one registration form per student.

Student's Name Student's Name First Last
Grade Entering in 2023-24

Grade Entering in 2023-24 Pre-K3 Pre-K4 Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade
Extended Day Choice

Extended Day Choice Drop-In Monthly
Mother's Name Mother's Name First Last
Mother's Place of Employment
Mother's Work Phone Mother's Work Phone - ### - ### ####
Mother's Cell Phone Mother's Cell Phone - ### - ### ####
Mother's Email
Father's Name Father's Name First Last
Father's Place of Employment
Father's Work Phone Father's Work Phone - ### - ### ####
Father's Cell Phone Father's Cell Phone - ### - ### ####
Father's Email
Living arrangements of child if not with both parents
Emergency Contact #1 Name Emergency Contact #1 Name First Last
Emergency Contact #1 Phone Number Emergency Contact #1 Phone Number - ### - ### ####
Emergency Contact #2 Name Emergency Contact #2 Name First Last
Emergency Contact #2 Phone Number Emergency Contact #2 Phone Number - ### - ### ####
Person #1 Authorized to Pick Up Student Name & Relation Note: Child will only be released to parents or persons indicated on this form unless other authorized arrangements are made (phone call or note to Extended Day Director).
Person #2 Authorized to Pick Up Student Name & Relation Note: Child will only be released to parents or persons indicated on this form unless other authorized arrangements are made (phone call or note to Extended Day Director).
Does your child require special medication or care? If yes, please explain.
List child's allergies, if any.
Does your student have any physical, mental or developmental disabilities that would prevent the child from participating in this program’s regular activities? If yes, please explain.
Physician's Name/Address/Phone Number
Dentist's Name/Address/Phone Number