Office use only

Date ________

Ck. # _______

Amt. _______

HK RECREATION CHILD CARE INVOIC

June 2^nd – June 18, 2008

Payments are due no later than Wednesday, May 28th ($5 per day late fee)

Tuesday and Wednesday, June 17^th and 18^th are ½ days of school.

June 18^th is the last day of school.

Child’s Name _______________________________________________ Grade _______ School __________

Child’s Name _______________________________________________ Grade _______ School __________

FULL-TIME:
After School at KES, HES and BES Sites

1 child = $162.50

2 children = $256.00

3 children = $305.00

PART-TIME:

After School at KES, HES and BES Sites

1 child = $14.00 per day; $24.00 per ½ day of school on 6/17 & 6/18

2 children =$24.00 per day; $41.00 per ½ day of school on 6/17 & 6/18

3 children =$30.00 per day; $51.00 per ½ day of school on 6/17 & 6/18

June dates: ___________________________________________________________

I hereby give permission for my child to participate in the HK Recreation Child Care Program for the above stated weeks / days.

______________________________________

Parent/Guardian Signature

All payments are due in full and should be returned with this completed form.

If two checks are being used for payment, both checks should be returned with this form.

_____ Check here if you would like a receipt FED Tax ID # 06-0974678 CT TAX ID #66-00-555-000

Please make checks payable to the HK Recreation Department

P.O. Box 569, 91 Little City Rd., Higganum, CT 06441

Higganum, CT 06441