BASC

SCHEDULE CHANGES

(Please check all days you will need care)

Child’s Name:___________________________________________

Change Effective Date: ___________________________________

Please indicate the days and times you would like to use BASC.

*Spaces will be filled on a first come, first served basis depending upon availability.

CHANGES MUST BE MADE BY THE 15^th OF EACH MONTH IN ORDER TO CHANGE

MONTHLY BILLING CHARGES FOR THE UPCOMING MONTH!

CHANGES REQUESTED AT OTHER TIMES DURING THE MONTH

WILL BE SUBJECT TO SPACE AVAILABILITY AND BILLING UPDATES.

	Cost:	Monday	Tuesday	Wednesday	Thursday	Friday
Before School: 7:00 - 8:00 am	$4.00
After School 1: 3:00 - 4:30 pm	$6.00
After School 2: 3:00 - 6:00 pm	$12.00
After School 3: 2:00 - 3:00pm (Tuesdays only)	$4.00
Drop In Care Only (When Available)	$5.00/hr

Parent Print Name __________________________________________

Parent Signature __________________________ Date ____________

Date Received: ______________ Change Approved: Yes No Confirmed: ____________

Billing Received Date: ______________ Billing Initial: _______________