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330 Hookstown Grade Rd, Moon Twp, PA 15108, (412) 264-9392


2020-2021 Study Care Program Fee Agreement/Contract



Child #1 Name:

Child #1 Date of Birth:

Child #1 Grade:

Child #1 School District and Name:

Child #2 Name:

Child #2 Date of Birth:

Child #2 Grade:

Child #2 School District and Name:

Child #3 Name:

Child #3 Date of Birth:

Child #3 Grade:

Child #3 School District and Name:

Other Participants:

Total Number of Child(ren) Enrolling:

  1. 1. A SPACE for your child
  2. 2. SUPERVISION of your child
  3. 3. Limited academic direction
  4. 4. Extension cords
  5. 5. Face shields
  6. 6. Hand sanitizer
  7. 7. Bottled water


  1. 1. All supplies needed to complete assignments (i.e., tablet, laptop, chargers, calculators,
    pens/pencils, etc.).
  2. 2. A bag lunch that includes a drink and eating utensils. The lunch must be ready to eat.  A
    refrigerator or microwave will NOT be available.
  3. 3. A face mask that must be worn during arrival and dismissal.


  1. 1. Non-refundable Application Fee: $25.00/one-time fee paid with submission of application. This can be paid by a check or credit/debit card.
  2. 2. Study Care Program Fee: $100/week paid every Wednesday of the month through auto pay account. (No refunds will be given for days absent.) This fee secures a space for your child regardless of how many days they actually attend.
  3. 3. Late Pickup: $15/1 to 15 minutes after 3:00 pm, paid by check or credit/debit card on
    Fridays.
  4. 4. Recess Activities: $0/included in the Study Care Program Fee


Please select the days for your child(ren)'s regular attendance: 7:30 AM - 3:00 PM:
MondayTuesdayWednesdayThursdayFriday

  1. 1. Medical Care, if required, will be paid for by the parent(s)/guardian(s).
  2. 2. Transportation to and from the center will be provided by the parent(s)/guardian(s).
  3. 3. No off premises activities will be offered.




I hereby affirm that the information above is accurate: Yes
Today's Date:
Initials and First/Middle/Last Name (i.e., JDS John Dean Smith):

Email Address To Send Form Copy:

Form Date: 12/1/2020