Extended School Service Program (ESS)

    Registration Form

    2015-2016

    Name of Parents:  _________________________________________________________

    Name of Child:  _________________________________   Grade:  _____

    Name of Child:  _________________________________   Grade:  _____

    Name of Child:  _________________________________   Grade:  _____

    Please choose payment schedule carefully.  Circle the category(ies) you will be using.

    Morning                      Monthly          Afternoon       Monthly          Morning and   Monthly

    Only (per week)          Cost                 Only                Cost                 Afternoon       Cost

    1-3 days                     $90.00             1-3 days          165.00             1-3 days          240.00            

    4-5 days                      115.00             4-5 days          210.00            4-5 days          300.00

    Pop-in:  $6.00 per hour

    0-15 minutes $1.50                 31-45 minutes $4.50

    16-30 minutes $3.00               46-60 minutes $6.00

    This is a contract.  Your payment schedule will not be changed to a lower amount without a 30 day written notice.  Additional billing will take place for any amount exceeding the contract.  Without prior arrangements, any use over what you have contracted, for will be billed at the most expensive pop-in rate.

    The contracted amounts are pro-rated as equal amounts for each month, and are paid September through May. The month of June will be half payment.

    Fees are to be paid one month in advance, beginning the 1st of September (example:  the September 1st payment covers ESS fees through the end of September).

    A late fee of $5 is charged for payment received after the 15th of the month.

    Accounts thirty days in arrears will result in the loss of ESS services.

     

    The full monthly payment selected will be charged regardless of actual usage.  Families picking up their children after 6:00PM will be charged an additional fee of $1.00 for every minute they are late.

    All school policies are to be adhered to for participation in the ESS Program.  In order to receive a letter of acceptance, all outstanding ESS fees must be paid in full unless prior arrangements have been made with the ESS Director.

    If families have more than one child, additional child(ren) will be charged half of the fees charged the first child.

    ESS is for our own school students and is conducted only when St. Pius X School is in session.

    ________________________________        _________________________________

    Parent Signature                                              Parent Signature

    ________________________________

    Date

    A copy of the Registration Form indicating acceptance will be sent to the parent with the signature of the school principal upon full payment of outstanding bills.

    _______________________________

    Principal’s Signature

    _______________________________

    Date