Columbus.cps.edu



Welcome to ASC at Columbus!

End each day with trusted care by a highly qualified, trained staff. Students will have a snack, be assisted with homework, have free play time outdoors (weather permitting), and structured enrichment activities.

Hours: Monday – Friday 2:45 p.m. – 6:00 p.m.

Registration:

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Child’s Name M/F

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Date of Birth Grade in Fall 2018

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Allergies/Medications

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Primary Parent Contact Name Date of Birth

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Address

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City State Zip

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Home Phone Work Phone

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Cell Phone email

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Secondary Parent Contact Name Date of Birth

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Address (if different)

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City State Zip

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Home Phone Work Phone

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Cell Phone email

Enroll in After School Care (must be the same days each week) Please note, once you commit to the days of the week, you must provide a notice to change in writing five days prior to the change. If you signed up for four days, but only attend three, you are still responsible to pay for the four days, unless you have alerted us in writing.

Days/week 5 4 3 2 1

Days of week M T W Th F

Fee Policies: Registration Policies:

|Payments are due weekly on Friday by cash, check, or money order to |Any medications, special needs, or medical information must be |

|Columbus Elementary School. It can be turned in to the ASC teacher or |submitted in writing at the time of registration. In the event that |

|to the Columbus main office. Please request a receipt if you are |ASC at Columbus determines that enrollment or continued participation |

|paying cash. Written notice must be given 5 days prior to the child’s |in ASC is not appropriate, ASC reserves the right to discontinue |

|last day in after school care. Participants are responsible for the |services. In such a circumstance, any unused portion of service fees |

|entire week if less than 5 days’ notice is given. |will be refunded. ASC reserves the right to cancel the enrollment of |

|You must pay for the number of days you signed up for during |an individual for reasons not limited to the following: not observing |

|registration, even if your child does not attend. You must give |rules of the ASC outlined in the Student Code of Conduct, physical or |

|written notice 5 days in advance if you are going to reduce the number|verbal abuse of staff or children, non-payment of fees. |

|of days your child will be attending. Your tuition pays the salaries | |

|of the ASC employees. | |

|If your child is picked up after 6:00 p.m., you will be charged $1.00 | |

|per minute that you are late. | |

Emergency Contacts:

|Emergency Contact |Emergency Contact |Emergency Contact |

|Authorized to Pick Up |Authorized to Pick Up |Authorized to Pick Up |

|Name: |Name: |Name: |

|Relationship to Child: |Relationship to Child: |Relationship to Child: |

|Phone: |Phone: |Phone: |

Authorization: ASC Policies: I agree to abide by all the ASC at Columbus payment and registration policies. Permission to Participate: I grant permission for my child to attend the After School Care program and release Columbus Elementary and Chicago Public Schools of all responsibility other than reasonable care. Minimum enrollment is required. No refunds unless the program does not run.

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Parent Signature Date

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Cost:

Fees cover each month and are divided into weekly payments

After School (per week)

5 days/week $60

4 days/week $56

3 days/week $48

2 days/week $36

1 day/week $20

Drop Ins: $25/session*

*24 hour notice required.

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