OCA After School Care Request Form

Afterschool Care Request

OCA Early Bird Afterschool Care Sign-Up Form (2025–2026)

This form is for the Early Bird Weekly Plan only. Families who complete this form and submit payment by Thursday of the week before will receive the 10% discount. Requests made after Thursday are not considered Early Bird and will be billed at the regular rate if space is available.

Child's Name(Required)

First Last Grade

Parent/ Guardian Name

First Last

Phone(Required)

Week(s) of Care This form covers the week(s) listed below. Please write the week of (e.g., “Week of September 9, 2025”) or check multiple weeks if planning ahead. Week of:(Required)

Additional Week(s) if any:

Schedule Selection (for each week selected)(Required)

Tuesday

Wednesday

Thursday

Pick up time(Required)

3:00- 4:00pm (one hour after school dismissal) - $10.80 for 1 child, $16.20 for 2 children

3:00–5:00 pm (two hours after school dismissal) – $21.60 for 1 child, $32.40 for 2 children

3:00–5:30 pm – $27 for 1 child, $40.50 for 2 children

Signature

Date

Afterschool Care Request

OCA Early Bird Afterschool Care Sign-Up Form (2025–2026)

Copyright. 2024 One Christian Academy. All Right Reserved

Table of Contents