Office
use only Date ________ Ck. # _______ Amt. _______
HK RECREATION CHILD
Payments are due no later than Friday,
Feb. 29th ($5 per day late fee)
March 21st, is
Good Friday, no school and no
child care program. Wednesday, March 26th,
Kindergarten Minimum Day .
Child’s Name
_______________________________________________
Child’s Name _______________________________________________
1 child = $230.00; $6.50 (1 child) for the
Kindergarten Minimum Day 2
children = $360.00; $11.00 (2
children) for the Kindergarten Minimum Day 3
children = $420.00; $16.00 (3
children) for the Kindergarten Minimum Day Please check the box if your
Kindergartener will be attending the 3/26 Min. Day Pro.
After School at 
PART-TIME: After School at 1
child = $14.00 per day; $24.00 for the the 3/26
Knd. Minimum Day 2 children =$24.00
per day; $41.00 for the 3/26 Knd. Minimum Day 3 children =$30.00
per day; $51.00 for the 3/26 Knd. Minimum Day March dates: _________________________________________________ Please check the box if your
Kindergartener will be attending the 3/26 Min. Day Pro.
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