Application fee: $5.00 per family (due with application).
| Full name of student (s) | School | Grade |
| 1. | ||
| 2. | ||
| 3. | ||
| 4. |
Please mark the days and sessions your child(ren) will be attending Clubhouse or Enrichment. Please note, children must attend a minimum of three (3) sessions per week.
| Monday | Tuesday | Wednesday | Thursday | Friday | |
| AM Clubhouse 6:30-8:30 am | |||||
| PM Clubhouse 3:15-6:00 pm | |||||
| Full Day Clubhouse 6:30 am - 6:00 pm | |||||
| 1/2 Day | AM | AM | AM | AM | AM |
| PM | PM | PM | PM | PM |
Circle appropriate answer:
| Child(ren) live with: | Both parents | Mother | Father | Guardian | |
| Person responsible for payment: | Both parents | Mother | Father | Guardian | FIA |
| Parent(s) Name | Home Phone | Work Place | Work Phone |
| 1. | |||
| 2. |
You are responsible for picking up your child(ren) by 6:00 pm or a late fee will be added to your bill. Drop off or mail this form to: CAPS Clubhouse, 505 Lester St., Cadillac, MI 49601.