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Extended Day Sign-up

Extended Day Application Form
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Please complete the form and submit.
  The JGS Extended Day manager will be contact with you regarding your application.
  Please see the Extended Day Program information page /extended-day for further information on pricing, times and requirements.
  
  Student Name & Grade: REQUIRED Please fill out this field. Please enter valid data.
  
  Student Name & Grade: Please enter valid data.
  
  Student Name & Grade: Please enter valid data.
  
  Parent/Guardian Name: REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent/Guardian Name: Please enter valid data.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Emergency Contact: (if parent cannot be reached) REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Phone Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Persons who have permission to pick up you child from Extended Day:
  
  Please list: REQUIRED Please fill out this field.
  
  I plan to use the Extended Day Program: REQUIRED Full time Drop-in basis Please fill out this field.
  
  Submit
  
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