Please mark days and times which apply to your needs. Before and After 7: 00 – 8: 20 a m. and 3: 40 – 6: 00 p m

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John Ross Before & After Care Program Application


Child’s Name_________________Grade_____Home #___________
Mother’s Name_____________Work #___________Cell #________
Father’s Name______________Work#_________Cell #__________

Please mark days and times which apply to your needs.
1. Before and After 7:00 – 8:20 a.m. and 3:40 – 6:00 p.m.
Mon_____ Tues_____ Wed_____ Thurs_____ Fri_____
2. Before Only 7:00 – 8:20 a.m.
Mon_____ Tues_____ Wed_____ Thurs_____ Fri_____
3. After only 3:40 – 6:00 p.m.
Mon_____ Tues_____ Wed_____ Thurs_____ Fri_____

On the back,

Please initial that you have read the following procedures and policies for the John Ross Before/After Care Program:

Rates and policies are subject to change per request from Edmond Public Schools.

_____ Rates:

I am aware these rates are subject to change.

# of Days Before & After Before After

5 $75 $43 $52

4 $63 $34 $44

3 $51 $28 $33

2 $39 $22 $27

1 $27 $16 $21

_____ Attendance:

I am aware that I am required to sign up for a certain amount of days for the week. The # of Days and/or the particular days that my child signs up for MAY NOT vary from week to week. I must commit to paying for all of the days that I sign up for, regardless of whether my child attends or not. I will not be charged for a school wide holiday, snow day, etc.

_____ Withdrawing:

I am aware that I must give the director two weeks advance notice if I wish to withdraw my child from the program. If I fail to give notice, my child can’t be readmitted into the program at a later date.
_____ Hours:

I am aware that the program closes at 6:00 p.m. If I arrive after 6:00 p.m., I will incur a late fee of $1.00 per minute.

_____ Payment:

I am aware that payment is due on Monday, prior to care, regardless of what day my child attends. I also understand that if payment is not received by close of Tuesday, I will be charged a $15 late payment fee in addition to my regular fees.

_____ Student Behavior:

All students are expected to follow the same rules and procedures of John Ross’s SOAR program (Stay Safe, Own Your Own Behavior, Accept Responsibility, Respect Relationships). Students who interfere with the quality of care for students or whose behavior creates a safety issue will be unable to continue participating in the JR Before/After Care Program.

The purpose of our policies and procedures is to be helpful and usable, and to strengthen our partnership with you. Please sign that you have read and agree to the conditions of our program. Thank you! Parents will be notified about their child’s enrollment status ASAP.
Parent Signature ______________________________Date________
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