SAINT MICHAEL SCHOOL
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Extended Day Care Program Form
Morning Program 6:50AM - 7:30AM - Afternoon Program 2:15PM - 5:30PM
$25 Registration fee will be added to your first bill
Please fill out one form for each child registered at Saint Michael School.
*
Indicates required field
Date/Month
*
January
February
March
April
May
June
July
August
September
October
November
December
Day
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
*
Grade/Teacher
*
Pre-K-Reinhard
Kindergarten-Berard
1st-DeLucia
2nd-Ouellette
3rd-Torres
4th-Geoffroy
5th-Decoteau
6th-Torres
7th-Dejadon
8th-Seeley
8th-Demers
Student Name
*
First
Last
Student Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mother's Name
*
First
Last
Mother's Cell Number
*
Mother's Work Number
*
Father's Name
*
First
Last
Father's Cell Number
*
Father's Work Number
*
Is your child in the custody of Both Parents?
*
Yes
No
Legal Guardian Name
*
First
Last
(only if someone other than parents)
Legal Guardian Cell Number
*
Legal Guardian Work Number
*
Name(s) of Person(s) to whom child will be released
Contact #1
*
First
Last
Relationship #1
*
Phone Number#1
*
Contact #2
*
First
Last
Relationship #2
*
Phone Number #2
*
Contact #3
*
First
Last
Relationship #3
*
Phone Number #3
*
Medical Information
Allergies
*
Is your child prescibed an Inhaler?
*
Yes
No
Health Issues
*
Is your child prescibed an Epi Pen?
*
Yes
No
Medications
*
Parent/Guardian Signature
Name of Parent / Guardian who filled out online form:
Name
*
First
Last
By checking the box below, I am stating that all the information filled out on this form and is true and accurate:
True and Accurate
*
Checked box confirmation
Submit
Home
Remote Learning
Forms
About
About SMS
Alumni
Calendar
Catholic Identity
Faculty & Staff
Our Parish
Principal's Message
Technology
Visit Us
COVID 19 Info
Admissions
Application for Admission
Tuition
Academics
Curriculum
>
Religion
English
Math
Social Studies
Science
Specialists
Students/Parents
Catholic Schools Week
Emergency Information Form
Extended Day & Childcare
FACTS
Food Drive
New Parent Information
In Person Learning or Remote Form
No School/Delays
Nurse Consent Form
NWEA Standards
Vaccination & Immunization
Recording Release Form
SMS Notices
Social Events and Fundraisers
Uniform Policy
Volunteers
School Buzz