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
$20.00 - 2 CHILDREN PER DAY OR $100.00 PER WEEK
$24.00 - 3 CHILDREN PER DAY OR $120.00 PER WEEK
Page by Elizabeth Sutterlin