Application for Extended Day

Application for Extended Day

Arab City Schools
The application window will open on June 22nd 2026!
Student FIRST Name
Student MIDDLE Name
Student LAST Name
Student's PREFERRED Name
Gender
Student Grade Level
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
- $15.00 Registration Fee
- $60.00 Per Week (pay is required for the full week)
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:
  - $15.00 Registration Fee
  - $45.00 Per Week (pay is required for the full week)
- Free & Reduced Pricing:
  - $30.00 Per Week (pay is required for the full week)
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):
Select which parents/guardians information you will be providing:
Mother/Guardian Information
Mother/Guardian Name

First NameLast Name
Is the Mother/Guardian authorized to pick up this student?
Does this student live with the Mother/Guardian?
Does the Mother/Guardian have Legal Custody of this student?
Mother/Guardian Cell Phone
Format: 000-000-0000.
Mother/Guardian Home Phone
Format: 000-000-0000.
Mother/Guardian Work Phone
Format: 000-000-0000.
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?
Does this student live with the Father/Guardian?
Does the Father/Guardian have Legal Custody of this student?
Father/Guardian Cell Phone
Format: 000-000-0000.
Father/Guardian Home Phone
Format: 000-000-0000.
Father/Guardian Work Phone
Format: 000-000-0000.
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:
Format: 000-000-0000.
Emergency Contact 2 Full Name:
Emergency Contact 2 Cell Phone:
Format: 000-000-0000.
Emergency Contact 3 Full Name:
Emergency Contact 3 Cell Phone:
Format: 000-000-0000.
Emergency Contact 4 Full Name:
Emergency Contact 4 Cell Phone:
Format: 000-000-0000.
Please list any health conditions/allergies:
I give permission for my child to be photographed during Extended Day.
Select the days of the week this student will attend Extended Day.
Signature*
Today's Date

MonthDayYear
Should be Empty:

Application for Extended Day

The application window will open on June 22nd 2026!

Mother/Guardian Information

Father/Guardian Information