Application for Extended Day

OLD VERSION Student Name:

First NameMiddle NameLast Name
Date

MonthDayYear
Date
The Extended Day Application is currently closed.

This form will be available on Monday, July 7, 2025.
The Extended Day Application is currently closed.
Application for Extended Day

Arab City Schools
Student FIRST Name*
Student MIDDLE Name
Student LAST Name*
Student's PREFERRED Name
Gender*
Student Grade Level*
Student's Homeroom Teacher
Student's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student lives with (select all that apply):*

ParentsMotherFatherGuardianFoster ParentOther
Select which parents/guardians information you will be providing:*

Mother/GuardianFather/Guardian
Mother/Guardian Information
Mother/Guardian Name

First NameLast Name
Is the Mother/Guardian authorized to pick up this student?

YesNo
Does this student live with the Mother/Guardian?

YesNo
Does the Mother/Guardian have Legal Custody of this student?

YesNo
Mother/Guardian Cell Phone
Mother/Guardian Home Phone
Mother/Guardian Work Phone
Mother/Guardian Email Address
example@example.com
Mother/Guardian Employer
Father/Guardian Information
Father/Guardian Name

First NameLast Name
Is the Father/Guardian authorized to pick up this student?

YesNo
Does this student live with the Father/Guardian?

YesNo
Does the Father/Guardian have Legal Custody of this student?

YesNo
Father/Guardian Cell Phone
Father/Guardian Home Phone
Father/Guardian Work Phone
Father/Guardian Email Address
example@example.com
Father/Guardian Employer
Information concerning custody of this student:
If a parent is not allowed to pick up a child, copies of court documents must be provided to the Extended Day Director.
Please list anyone (other than the parent/guardians entered above) who may pick up this student or be contacted in case of an emergency:
Emergency Contact 1 Full Name:
Emergency Contact 1 Cell Phone:
Emergency Contact 2 Full Name:
Emergency Contact 2 Cell Phone:
Emergency Contact 3 Full Name:
Emergency Contact 3 Cell Phone:
Emergency Contact 4 Full Name:
Emergency Contact 4 Cell Phone:
Please list any health conditions/allergies:
I give permission for my child to be photographed during Extended Day.*

YesNo
Select the days of the week this student will attend Extended Day.*

MondayTuesdayWednesdayThursdayFriday
PreK Student Extended Day Information

Space is limited. Extended Day applications will be processed in the order received.

Parents of students accepted to the program will receive an email directly from ProCare concerning fee payments.
- Fees will be invoiced online through ProCare
- $10.00 Registration Fee
- $45.00 Per Week / $9.00 Per Day
K-5 Student Extended Day Information

Space is limited. Extended Day applications will be processed in the order received.

Parents of students accepted to the program will receive an email directly from ProCare.
- Fees will be invoiced online through ProCare
- Extended Day Pricing:
  - $10.00 Registration Fee
  - $30.00 Per Week / $6.00 Per Day
- Free & Reduced Pricing:
  - $15.00 Per Week / $3.00 Per Day
Signature*
Today's Date

MonthDayYear
Should be Empty:

Application for Extended Day

Mother/Guardian Information

Father/Guardian Information