Dear Parents/Guardians:

Weymouth Township School will be operating an after school care (ASC) program during the 2005-2006 school year. The program operates 3:00 to 6:00 PM or 1:00 to 6:00 PM on single session days such as the days we hold parent conference. All students must be picked up prior to 6:00 PM. We will be open every day school is in session except the half days before Thanksgiving, Winter break and Spring recess.

The cost is $6.00 per day per child. There is a two day a week minimum sign up required..

You will need to fill out and hand in the attached calendar. Since we are starting the last week of October, please indicate for both that week and all of November the days your child/children will need care. Please return both the calendar and payment (check made out to Weymouth Township ASC) by Thursday, October 21. Full payment for the last week of October and all of November must be made at that time. Without both, you child will not be accepted into the program.

If you decide to send your child/children home on a day you signed up for (you must send a note into the main office so we know they get on the bus), you will be charged for that day. If your child is sick on a day you signed up for, you will be charged for that day. If school is closed due to a weather emergency, you will be credited for that day.

Also, children can only attend after school care for those days you have signed up for – we will not accept drop-in children.

Child/Children's  Name(s)

Home address

Name of parent/guardian

Emergency numbers to be reached during program’s hours:

Emergency phone # and Cell

List below the names of additional emergency contacts and their phone number

I anticipate my child/children will attend ____ days per week

My child/children may only be released to the following individuals unless notified in writing:

Name Relationship Phone #

Name Relationship Phone #

My child/children are allergic to:

Other health information we should be aware of: