Additional Care Day Request Form | UCLC | University of North Dakota

Parent/Guardian Name: *

Parent/Guardian ID Number:*

Child's Name: *

Date(s) of additional care being requested: *

Are you willing to have your child in another color family if there is space available on the dates requested? (This does not apply to the Red Family.)

Yes
No

I understand that if the additional care days are approved, I will be billed according to the following rate: $53.00/day for school-age and preschool and $66.00/day for toddlers.

Yes
No

I understand that I will be charged for these dates whether my child does or does not attend (for example, if my child is absent due to illness or change of plans).

Yes
No

I understand I will be assessed a separate fee in addition to my regularly scheduled bill.

Yes
No

I understand that I cannot “exchange” a regular day of my schedule for a day outside my schedule (i.e., if my child attends Tuesday/Thursday, I cannot “exchange” one of the Tuesdays for a Monday, Wednesday, or Friday).

Yes
No

I understand that the extra day requested is not approved until I receive an email confirmation back from the UCLC administrative team.

Yes
No

Parent/Guardian Signature (typed signature is acceptable)*

Reminder: Payment is not due until the charge slip has been prepared.