St. Augustine School

Eagle Park

Ossining, New York  10562

Extended Day Form

• An extended day program is available. The program begins at 2:30 p.m. and ends sharply at 5:30 p.m.
• The cost of this program per day is $10.00 for one child, $17.00 for 2 children and $21.00 for 3 children.
• The extended program is not held on half days.
• New payment policy: Payments for this program must be made daily or on the last day of the week that the extended day program is in session. (Note: When payments are not made in a timely matter, discrepancies may occur in accurately billing actual days that the program was used.)

NAME_____________________________________ GRADE _______

NAME_____________________________________ GRADE _______

NAME_____________________________________ GRADE _______

EMERGENCY CONTACT NUMBER _________________________

WEEK OF _____________________OR DAILY __________________

DAYS _____________________________________________________

AMOUNT __________________ TOTAL # OF CHILDREN ________

$11.00 - 1 CHILD PER DAY OR $55.00 PER WEEK

$18.00 - 2 CHILDREN PER DAY OR $90.00 PER WEEK

$22.00 - 3 CHILDREN PER DAY OR $110.00 PER WEEK