Before and After-School Care Enrollment Form

OCA Before and After School-Care Enrollment Form

Directions: Please complete the OBA Before and After-School Care Enrollment Form to enroll your student.

If you need to use the drop off services, please complete this enrollment form at least one day prior so Before and After-School Staff can be prepared for the student.

Today's Date *

Student Name *

Student's Date of Birth *

Homeroom Teacher and Grade Level *

Academic Year (i.e., 2023-2024) *

Before and/Or After School Care Needs

Please complete the following questions about the type of before and/or After School Care needed.

If you do not need one of the care types, please write “NA” for not applicable.

Before School Care

Days and Times Needed (Monday-Friday)

Start Date

End Date

After School Care

Days and Times Needed (Monday-Friday)

Start Date

End Date

Please provide any details about your student that Before and After-School Staff may need to know.

Before and After School-Care Acknowledgement

I have read the OCA before and after school policy. * (1 required)

Yes No

I understand that I will be charged a fee for dropping off my student(s) early & picking up late. * (1 required)

Yes No

Parent or Guardian's Name *

Date Label *

Parent or Guardian Phone Number *

Parent or Guardian Email *

Parent or Guardian Address *

Address 1
Address 2

City

State

Zip

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Email *

Emergency Contact Address *

Address 1
Address 2

City

State

Zip

Enter Your Email Address: *