Extended School Day Information Form

Please complete the following form for your child to attend Paul R. Smith's Extended School Day program. Extended School Day is on Monday's and Tuesday's from 7:30am to 8:30am.

Your Child's (student) Name Your Child's (student) Name First Last
Student ID Number
Phone Phone - ### - ### ####
Email
Please sign below as consent for your child to attend ESD. I understand transportation is not provided and I agree to transport my child.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.