Request for Daycare Stop 2025-2026

PLEASE COMPLETE A SEPERATE FORM FOR EACH CHILD

REQUESTS FOR DAYCARE MUST BE SUBMITTED BY JULY 31, 2025

PLEASE PRINT CLEARLY AND FILL OUT FORM COMPLETELY

Student's Last Name *

Answer required for "Student's Last Name "

Student's Fist Name*

Answer required for "Student's Fist Name"

Home Address*

Answer required for "Home Address"

Parent/Guardian First & Last Name*

Answer required for "Parent/Guardian First & Last Name"

Parent/Guardian Contact Telephone Number*

Answer required for "Parent/Guardian Contact Telephone Number"

Parent/Guardian Email *

Answer required for "Parent/Guardian Email "

Grade in 2025-2026 School Year*

Answer required for "Grade in 2025-2026 School Year"

Daycare Name*

Answer required for "Daycare Name"

Daycare Address*

Answer required for "Daycare Address"

Daycare Phone #*

Answer required for "Daycare Phone #"

Cost for Transportation

Families in grades K thru 6 who live less than 2 miles from school and all students in grades 7 thru 12 are required to pay for busing.

1st student is $250.00 with a family cap of $450.00 for 2 or more students. Payment is due by July 31, 2025. After July 31st the payment will be $275.00 and $475.00

Payment Method*

Answer required for "Payment Method"

Paid on Unipay

Paid by Check

We are in grade K-6 and live 2 or more miles away from the school

Will submit sharing form received from School Department

Please fix the highlighted areas below before submitting.

Request for Daycare Stop 2025-2026