CARY ACADEMY

Extended Day Program               Enrollment Form 2005-2006 

Student Name________________________________________________________________  Grade ________ 

I would like to enroll my child in the following Extended Day Program option: 

_______ Full Use  3:10 PM  to 6:00 PM (entire month)

              Cost Flat Rate: $18 per day X days in the month (no refunds for unused days) 

_______  Partial Use  3:10 PM to 6:00 PM (indicate days below)

                Cost $21 per day attended by student during the month.

Please indicate which days your child is likely to attend ( we do recognize that this may vary)

                ______Mon  _____Tues  _____Wed  _____Thur  _____Fri 

For students who are participating in athletics, intramurals or other extracurricular activities, special arrangements may be made for an hourly rate of $9.00 (in one hour increments). 

Extended Day is also available to all parents on an emergency basis at a cost of $25 per day! 

Extended Day options may be changed at the beginning of each trimester (only) in order to accommodate the changing schedules of students and parents.  Such changes must be made through the Extended Day Coordinator.

 All Extended Day fees are billed at the end of each month and are due upon receipt.  Failure to pay fees in a timely manner may result in a student being denied admission to the program in the future. 

I understand that a late fee of $5.00 will be imposed for every ten-minute increment or part thereof for children picked up after 6:00 PM.  The late fee is due at the time I pick up my child.  Chronic abuse of the late policy or failure to pay late fees will result in my child not being able to continue participation in the program. 

I also understand that my child is expected to abide by the rules of Cary Academy and the Extended Day Handbook.  Failure to do so may result in an immediate loss of participation in the Extended Day Program.  I further understand that the policies and procedures of the Extended Day Handbook will be followed for the good of all concerned. 

Signed_____________________________________  Date________________________ 

Telephone numbers (please indicate best numbers to use between 3:15 and 6 pm): 

Home_________________________________Cell Numbers______________________________ 

Mom’s work______________________________Dad’s work_____________________________ 

Please  return  form  as soon as possible