School Age Care

Student’s Name*

Grade*

Date of Birth*

5% discount for all SAC children after the first child

Please make your program selection below:

am care (7:00-8:15)

5 days per week - Ten Payments $126

5 days per week - One Payment $1,110

pm care (until 5:30pm)

5 days per week - Ten Payments $228

5 days per week - One Payment $2,130

3 days per week - Ten Payments $181

3 days per week - One Payment $1,660

2 days per week - Ten Payments $195

3 days per week - One Payment $1,800

am & pm care

5 days per week - Ten Payments $307

5 days per week - One Payment $2,920

3 days per week - Ten Payments $259

3 days per week - One Payment $2,440

2 days per week - Ten Payments $195

2 days per week - One Payment $1,800

*A $25 late fee will be added for all payments received after the 15th of each month.

Please choose payment option by checking one box below:*

One time payment option

Ten payment option: with payment by check: Daycare is paid monthly, over a 10-month period, which begins September 2026 and ends June 2027. I will make the monthly payments by check or cash.

Ten payment option: with payment by Tuition Express: Daycare is paid monthly, over a 10-month period, which begins September 2026 and ends June 2027. I will make the monthly payments by Tuition Express.

Parent/Guardian Signature (typed)*

Date

Please check box*

I understand that my child’s/children’s enrollment in School Age Care is based upon keeping my account balance current.

I understand that if my account becomes delinquent, my child’s/children’s enrollment in Christ Lutheran School could be impacted.

School Age Care closes at 5:30pm. At 5:31pm, you will be charged a late fee of $15.00. At 5:46pm, and every 15 minutes thereafter, another $15.00 will be due. Late fees are due in cash at pick up, to the staff member present.

I understand my child/children is expected to follow the same rules regarding behavior and cell phones as stated in the Christ Lutheran School Handbook.

I understand that I, as parent/guardian, will be held to the standards of personal conduct set forth in the Christ Lutheran Parent Partnership Covenant Agreement as referenced in the Christ Lutheran School Parent Handbook.

I understand that if there is a behavior problem with a child in School Age Care, the parent/guardian will be notified. If the behavior continues to become a problem, the child will be removed from School Age Care at the discretion of the Director and Principal.

The Parent/Guardian who has signed this agreement will be personally and fully responsible for the payment of all tuition and fees accrued. A $25 late fee will be added for all payments received after the 15th of each month.

I understand that to terminate enrollment in School Age Care I must notify the School Age Care Director before the first of the month to withdraw or change care schedule.

Parent/Guardian Signature (typed)*

Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

CAPTCHA

Number

Child needs SAC staff need to be aware of

SCHOOL AGE CARE PROGRAM MONTHLY PLAN REGISTRATION & FINANCIAL AGREEMENT 2026-2027

SCHOOL AGE CARE PROGRAM 2026-2027

5% discount for all SAC children after the first child

*A $25 late fee will be added for all payments received after the 15th of each month.

Christ Lutheran Church & School