Form from: Saint Maximilian Kolbe Catholic School (540-1212-SK1)

The Extended Day Program is for students in grades K-8.

Cost: $6.00 per student / per hour

Before school hours: 7:00am - 8:00am

After school hours: 2:30pm - 5:30pm

Parent / Guardian Name (First Contact)

Email Address

Home Phone

Work Phone

Cell Phone

Parent / Guardian Name (Second Contact)

Email Address

Home Phone

Work Phone

Cell Phone

Complete the following for each of your children that will be attending Extended Day.

Student 1

BEFORE SCHOOL SCHEDULE (check all that apply)

AFTER SCHOOL SCHEDULE (check all that apply)

Student 2

BEFORE SCHOOL SCHEDULE (check all that apply)

AFTER SCHOOL SCHEDULE (check all that apply)

Student 3

BEFORE SCHOOL SCHEDULE (check all that apply)

AFTER SCHOOL SCHEDULE (check all that apply)

Student 4

BEFORE SCHOOL SCHEDULE (check all that apply)

AFTER SCHOOL SCHEDULE (check all that apply)

Student 5

BEFORE SCHOOL SCHEDULE (check all that apply)

AFTER SCHOOL SCHEDULE (check all that apply)

Your name

Your email