REACH CARE FROM DISMISSAL UNTIL 5:30PM

Afternoon Drop-in Registration & Payment

REACH is currently able to accommodate Drop-ins on Mondays, Thursdays & Fridays. This form is for families WHO ARE NOT ALREADY ENROLLED in the Full Year or the Current Term of REACH Care.

Drop-in Afternoon REACH Care
Student Full Name*
Student Grade*
Date of REACH Care
MM slash DD slash YYYY
APPROXIMATE PICK UP TIME*

: Hours

Minutes

AM/PM
Parent Full Name*
Parent Email*
Credit Card
Card Details
Cardholder Name
Address*
Street Address Address Line 2 City State ZIP Code
Total Cost
$0.00
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Comments
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