Before & After School Care

$6.25 per hr. (minimum of $6.25 per day)

Child's Name:  

Date of Birth:

Parent / Guardian Name/s:

Street

City

State

Zip code

Parent / Guardian - Phone Numbers

Child'sDoctor

List anyone other than parents who has permission to pick up your child and their phone numbers:

In the event of an emergency I give Spring Street Community Care & Recreation Inc. staff permission to obtain health care for my child.

Parent / Guardian  Digital Signature

Today's Date

Your Email Address

 

 

 

 

  • A copy of your child's most recent Physical and Immunization records are required on start date.
  • Financial Assistance may be available. Call Kristy @ (315) 889-1722
  • Payments are due at the beginning of each week.
  • Checks can be made out to Spring Street CC&R

963 Spring Street Rd., Union Springs, NY 13160