St. Augustine School
Eagle Park
Ossining, New York 10562
Extended Day Form
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
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