Registration Form for Extended Daycare Hours Pedagogical Day Please select the follow PED that your child will be present * PED days are from 7:15 am to 5:00 p.m. and cost 30$ per day per student September 27 October 18 November 21 November 22 February 10 April 4 April 25 June 6 Name of Child: * First Name Last Name Grade: * Medicare Card Number and Exp. Date Name of Child: * First Name Last Name Grade: * Medicare Card Number and Exp. Date Name of Child: * First Name Last Name Grade: * Medicare Card Number and Exp. Date Authorized Guardian * First Name Last Name Phone * (###) ### #### * By checking this box you agree to pay the fees Thank you!
