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Extended Care Registration

Extended Care Registration
  • Parent/Responsible Party's Contact Information

  • Enrollment Information

  • EMERGENCY CONTACT (if parents can not be reached)

  • Medical Information

  • In case of EMERGENCY, if the undersigned parent(s) or responsible party cannot be reached by phone, consent is given to take my child/children to:

  • The aforementioned doctor, or in the event of his unavailabliity, any doctor on staff of said hospital, is authorized to utilize whatever medical techniques are deemed necessary including surgery. The undersigned acknowledge their responsibility for all reasonable medical expenses so incurred.

  • Allergy or Medical Condition

  • Approved Pick-Up List

    The following individuals have permission to pick up my child from Holy Souls Extended Care.  (Type N/A if this does not apply)
    Anyone not listed must have written permission from a parent/guardian or the parent/guardian must speak directly the HSE director.
  • Statement of Responsibility

  • I have read the Handbook and I understand that my child must adhere to the regulations while he/she is in attendance on the Holy Souls campus or any scheduled field trips. In the event that I am uncertain of some aspects of the Extended Care policy I will contact the Director for clarification.

  • Holy Souls Extended Care uses the following methods of descipline:

    Verbal Warning

    Time Out

    Parent Contacted for Conference

    Dismissal from the Program

  • If you do not agree with the disciplinary method above list your preferred method.


    Note: Physical punishment shall not be administered to children under the age of three (3) years. (minimum licensing requirements for child care centers 500.10,p.11) 

  • Interviewing Children

    In accordance with Minimum Licensing Requirements: DCCECE/Child Care Licensing Unit: 200.3 Child Care Licensing/Investigators/Law Enforcement may possibly interview your child. 

  • Photo-Video Release

  • Permission

  • Fees

  • Costs include a $35 registration fee and a $225 activity fee; both fees are due when you register. 

    Payments are made through the FACTS account for Holy Souls students. 

    If you do not have a FACTS account payments are due Monday of each week you are attending.


    The weekly tuition is $140 for Holy Souls students and $150 for non-Holy Souls students.  The daily/drop-in tuition is $40 for Holy Souls students and $50 for students not attending Holy Souls School. 


    The electronic signature below and its related fields are treated by Our Lady of the Holy Souls Extended Care like a physical handwritten signature on a paper form. 

    Agreement: My signature above affirms that I attest that all information included in this application form is true and accurate. I understand that any willful omission or untrue statement could result in my child losing his/her seat in Our Lady of the Holy Souls Extended Care.