Westside Community Church VPK
1937 Lakeville Rd
Apopka, FL 32703
Website: www.westsidecc.org
Phone: (407) 398-9509
Extended Day and Wrap Around Care Registration Form
2012-2013
Child’s Name ____________________________________________________________________________
Last
First
Date of birth
Parents or Guardians ______________________________________________________________________
Mother
Father
Cell/Emergency Contact Information
Phone _______________________________
_________________________________
Mother
Father
Who else is authorized to pick up your child?___________________________________________________
Name _______________________________ Phone _____________________________________________
Name _______________________________ Phone _____________________________________________
Address:________________________________________________________________________________
_______________________________________________________________________________________
Allergies________________________________________________________________________________
_______________________________________________________________________________________
E-Mail Address __________________________________________________________________________
We will use this as a means of communication during the school year.
Please check the services required:
Additional Services & Fees:
Please check the services required
Pre-K 3
______ Potty trained? Yes_____________ No _______________
Services & Fees:
Pre-K 3 hours per day
______ 9am-12noon
$50 per week
Part Time 6 hours per day
$75 per week
______ 8:30am-2:30pm
Full Time 11 hours per day
$125 per week
______ 7am-6pm
Pre-K 4 (Child must be 4 and completely toilet trained by September 1, 2012)
______ VPK Monday through Friday 8:30 am- 11:30 am (drop off 8:00 ok)
Welcome
to our
Voluntary
Prekindgarten
Education
We areSee
glad
you have decided to join
______
VPK Class
B Mon-Fri
12:30-3:30pm
(wrap
aroundProgram!
care available*
below)
us for
a funAround
year fullCare
of hands on learning.
Morning
Wrap
______ Class B Wrap Around 7am- 4pm
$50 per week
______ Class B Wrap Around 7am-6pm
$65 per week
Afternoon Extended Care
VPK Class A 11:30-6pm
(drop off 7/8am)
$65 per week
Afternoon Care (Lakeville VPK Wrap)
______ 11:10am-4pm (walk to pick up)
$50 per week
______ 11:10-6pm (walk to pick up)
$65 per week
Morning & Afternoon (Lakeville)
______ 7:00am-8:10& 2:40-6pm (walk/drop/pick) $40 per week
______ Registration Fee
$50 One Time/Yearly
Our Mission and Vision is provide a “high- quality hands on learning experience for four year olds in our
community. After school program will include snack, homework help and playground time. Please let me
know if you have any questions: Amy Scott Director 407-398-9509 Cell#