MoorestownTownship Public Schools

Moorestown Township Public Schools 

Extended Day Care Program Registration Form 2019-20 School Year

One Form Per Student

Student's Full Name:   

School Attending in 2019-20:  Grade in 2019-20: 

Address

Street:  City:  State:  

Zip: 

Legal Guardian #1 Information

Full Name: 

Cell Phone:  Work Phone: 

E-Mail 

Legal Guardian #2 Information

Full Name: 

Cell Phone:  Work Phone 

E-Mail: 

If Yes, who has Custody? 

AUTHORIZATION FOR PICK-UP

Your child will only be released to an authorized person listed on this form (parent/guardian and/or emergency contact). In case of emergency or an unforeseen circumstance, please indicate the name and phone number of any other person/s who you authorize to pick up your student on your behalf.

Contact #1 Name:  Phone Number: 

Contact #2 Name:  Phone Number: 

Contact #3 Name:  Phone Number: 

Medical Information

Provide details about anything checked above: 

List all current medications, prescribed and over the counter:  

Any additional information that may be useful for us to know: 

I give my permission for the Extended Day Care Personnel to seek qualified medical attention in the event of any emergency if a parent/guardian cannot be contacted.

 I understand my student(s) will not be released to any person not listed on this form. I understand that it is my responsibility to notify each person listed that a picture ID is required to release my student(s) from Extended Day Care.

 I understand my student(s) must be picked up by 6pm. If not, I will be charged $20 per child for every 15 minutes the student is left in Extended Day Care. If no contact has been made with the parent/guardian or the emergency contacts by 6:30 pm, the authorities will be notified.

Basic Rates

DROP IN PASS BOOKLETS: 5 Passes/$155.00; Each pass is good for 1 child/1 visit to Extended Day Care.

Multiple Child Discount

1 ST CHILD – FULL TUITION

2 ND CHILD – 10% OFF APPLIED TO OLDER CHILD'S TUITION.

3 RD CHILD – 15% OFF APPLIED TO OLDEST'S CHILD TUITION.

Enrollment Policy

Please understande that once you register for an option listed above, you are not permitted to switch the option without 30 days written notice to: mtpsedc@mtps.com. If you chose to send your student(s) less days than initially registered for in a month, you will not be prorated or credited any missed days in that month.

DAILY DROP IN PASS OPTION: The Drop In Passes are designed for families who require occasional care. Each pass is good for 1 child/1 visit to Extended Day Care. On the day the pass will be used, please provide notification of your child's attendance via call or text to the Extended Day Care Cell: 856-780-0502. In addition, please notify your child's school that they will be attending. The pass should be completed in its entirety and sent to school with the child to be given to the Extended Day Care site director. Drop In passes must be purchased in advance and please allow 1 week for processing. Extended Day Care staff members are not permitted to accept payments.