Extended Child Care

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Main Office: 335 College Avenue Santa Rosa, California 95401 707.545.2402

Extended Child Care Summer and Fall 2008 Care Request Form

Please note that this form will not automatically transmit without being fully completed.
(* denotes required fields)

Then press the [Send] button at the bottom of the page:

Use any of the following ways to enroll your child for summer care and tell us of your plans for care in the Fall. Please respond by April 15, 2008. Don’t forget to sign your name at the bottom of the form!
1. Complete the form and mail it with your payment.
2. Complete the form and fax it to the main office at (707) 545-4860.

If you do not know your child care needs for Fall at this time, please check the box under the Fall 2008 Care section and return the form to us as indicated above. Don’t forget to follow up in writing by July 15 with your Fall schedule!

Summer Care
Families must have a zero balance on their childcare bill to use summer care.

The minimum weekly schedule available for Summer is 3 Full days (more than 4 hours per day), or 5 Part days (0-4 consecutive hours per day).
Families signing up for Part day care should be aware that if your child attends a field trip which lasts more than 4 hours, your bill for that day will be adjusted to the full day rate.
There is a 4-week drop notice required for any summer schedule.
ECC Centers are open 7am-6pm during the summer.
Care is provided on a first-come, first-served basis.

Child's Name*:

Your e-mail*:

Parent's Name*:

Center your child currently/will attend::

Brooks	Cali Calmecac	J.X. Wilson
Mark West	Mattie	R. L. Stevens
Riebli	San Miguel	Windsor Creek
Wright

Summer Care:

No	Yes (If yes please indicate your schedule below)

Summer Care

	Monday	Tuesday	Wednesday	Thursday	Friday
5 Full Days		The Full Day Rate is $25.75 per day (up to 4 consecutive hours)
4 Full Days Please indicate the days your child will attend
3 Full Days Please indicate the days your child will attend
5 Part Days Please indicate the days your child will attend		The Part Day Rate is $12.75 per day (more than 4 hours)
Care needed during Summer School		– If you plan to enroll your child in summer school, please call the main office after you have received confirmation from the school that your child is enrolled in summer school. We will create a summer school-only schedule for your family at that time.

Fall 2008 Care The minimum weekly schedule is 3 days per week. If you do not inform us in writing by July 15, 2008 of your child’s schedule for the Fall, your child(ren) will be dropped from the program.

No, we are dropping care. My Child's last day will be
Yes, and I will keep the same schedule as last year.
Yes, and my child's new schedule will be (please indicate below).

	Monday	Tuesday	Wednesday	Thursday	Friday
Before School
After School Only
I am unsure at this time, but will let you know by July 15th, 2008		I understand that if I do not respond by this date, my child(ren) will be dropped from the program.

I have an incoming Kindergartner for Fall 2008
Child's Name*:
Date of Birth*:
Name of enrolled sibling*:

Please enter your message or let us any know special needs:

Thank you - Gracias

Extended Child Care Main Office: 335 College Avenue Santa Rosa, California 95401 707.545.2402