ACA Extended Care Community Enrollment

Please complete the registration below to reserve your Extended Care spot for the 2023-2024 school year.

Extended Care will be billed on the quarter hour and families will receive a monthly bill for care to be paid through their FACTS account.

If you are registering more than one child, you will need to complete a registration form for each child.

Community families that plan to use pick up and drop off from another school will be asked to provide a booster seat for their child if appropriate.

Should you have any questions, please contact the school.

Where will your child attend school for the 2023-2024 school year

Please select the type of care you plan to utilize

AM Care PM Care Activity Day Care

Student Information

Name (First, Middle) Last

Gender

Male Female

Date of Birth

Address

Primary Phone

Primary Email

This address will receive a confirmation email

Does your child have any medical needs (allergies, etc)

Family Information

Father's Name (First, Middle, Last)

Address

Home Phone

Cell Phone

Work Phone

This address will receive a confirmation email

Occupation

Employer

Mother's Name (First, Middle, Last)

Address

Home Phone

Cell Phone

Work Phone

This address will receive a confirmation email

Occupation

Employer

Marital Status of Parents

Married Separated Single Divorced Widowed

Payment

Review and Select each payment option/price before completing the form. Card payment includes the transaction fee. ACA will accept cash or check; however the registration will not be confirmed until payment is received.

Extended Care Enrollment Fee

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

ACA Extended Care Community Enrollment

Description

Please Fix the Following