Parent/Student Handbook - St. Rose-McCarthy Catholic School

EXTENDED CARE REGISTRATIONST.ROSE-McCARTHY AFTER SCHOOL PROGRAMCHILD OR CHILDREN'S NAME GRADE DAYS HOURS___________________________ _______ ______ __________________________________ _______ ______ __________________________________ _______ ______ __________________________________ _______ ______ _______DAYS ATTENDING AFTER SCHOOL PROGRAM: M____ T____ W____ TH____ F____General Time Your Child(ren) will be picked up:____________________________________CHILD OR CHILDREN'S ADDRESS________________________________________________________Phone____________Street Address ________________________ City __________________ Zip code _______FATHER/STEP-FATHER Name ______________________________ Phone____________FATHER/STEP-FATHER Address______________________________________________FATHER/STEP-FATHER Work Place, Address ___________________________________Phone #’s _________________ ____________________ ___________________MOTHER/STEP-MOTHER Name _____________________________Phone____________MOTHER/STEP-MOTHER Address ____________________________________________MOTHER/STEP-MOTHER Work Place, Address___________________________________Phone #’s ___________________ _________________________________________ALLERGIES (i.e. food, bees, wasps, etc.)__________________________________________________________________________________________________________________________________________________In the event of an apparent serious illness or accident, when I cannot be reached, I wish oneof the following to be notified by telephone. They are AUTHORIZED to act in my absence.They may also release my child from the After School Program. If it is necessary to call anambulance, I authorize the After School Program to do so: YES_____ NO______Name _____________________________________________Phone #________________Address__________________________________________________________________Name _____________________________________________Phone #________________Address__________________________________________________________________Name _____________________________________________Phone #________________Address__________________________________________________________________PARENT'S/GUARDIAN SIGNATURE_____________________________Date___________PARENT'S/GUARDIAN SIGNATURE_____________________________Date___________38