Please add all of your children that will be in BAC.
Rates: $5.00/hr. for K3 and K4, $4.00/hr. for grades K-8. A 1 hour minimum will be charged.
Note: Children at school past 11:15am or 3:15pm unsupervised will be placed in After Care.
Agreements & Consent
Please read the following agreements and check the box below. Checking the box means that you agree to the
terms and provisions outlined below.
This agreement must be made by the person(s) who will be responsible for the payment of fees. Fees will be
paid online at the church website. An up-to-date email address is needed to submit daycare calendars and
to receive invoices regarding your daycare fees. We will also be using email to notify parents of changes
in daycare policy or other information. Please read this carefully so that you understand it.
I (We) am (are) registering for Peace Lutheran School's Before and After Care Program (BAC).
If I (we) modify this schedule, it must be done through the online BAC Scheduler and/or the BAC Coordinator.
At the same time, I (we) agree to pay the fees ($5.00/hr. for K3 and K4,
$4.00/hr. for grades K-8) for that schedule as well as the once yearly
$25.00 registration fee per family.
For planning purposes we are asking that the registration fee be paid by check for K-8 children on
Registration Day in August or for K3/K4 children on Orientation night in August at the BAC table.
Note: Please see all schedule policies in the BAC handbook at
Emergency Medical Consent
In order to protect the health and safety of its students, Before and After Care may need to obtain
emergency medical treatment for students when the parents are not available. Therefore, the School must
respectfully require that Parents/Guardians of all students at Peace Lutheran School must agree to this
policy. By checking the box below, the parent authorizes the School administration, teachers and
coaches to seek medical treatment by EMT, physician or hospital staff in the event that (a) the student has
sustained an injury or developed an illness which may, in the discretion of the school staff, substantially
endanger the child's health if not treated immediately and (b) the student's parent could not be reached. This
authorization also authorizes release of the student's medical records and information to the treating provider to
the extent necessary to provide immediate medical treatment. The parent or guardian releases Before and After
Care and its staff members from liability for seeking such treatment, for the treatment which is obtained, and
for the results of that treatment. This permission covers all activities in which the student chooses to
participate as a student of Before and After Care. I hereby give permission for transportation via ambulance to a
local hospital and for medical treatment deemed necessary by a physician who is designated by the school
authority. I understand that Before and After Care will attempt to obtain treatment from preferred physicians
and hospitals, but may seek treatment from any provider if necessary.
I (We) have read the above statements, attached policies
and handbook of Peace Lutheran School and Peace Lutheran Before and After Care Program, and agree to
register my (our) child(ren) in the program, and to be responsible for the regular monthly online payment fees
including the $25.00 registration fee per family and any additional amounts due for late fees.