Office
use only Date ________ Ck. # _______ Amt. _______
HK RECREATION CHILD
Payments are due no later than Tuesday,
April, 29th ($5 per day late fee)
Friday, May 23rd is a half day
of school. No school on Monday, May 26th,
Memorial Day. Wednesday, May 28th, Kindergarten Minimum
Day.
Child’s Name
_______________________________________________
Child’s Name _______________________________________________
1 child = $248.00; $6.50 (1 child) for the
Kindergarten Minimum Day 2
children = $389.00; $11.00 (2
children) for the Kindergarten Minimum Day 3
children = $457.00; $16.00 (3
children) for the Kindergarten Minimum Day Please check the box if your Kindergartener will be
attending the 5/28 Minimum Day
Pro.
After School at 
PART-TIME: After School at 1
child = $14.00 per day; $24.00 (1 child) for the 5/23 half day or the
Kindergarten Minimum Day 2 children =$24.00
per day; $41.00 (2 children) for the 5/23 half day or the Kindergarten
Minimum Day 3 children =$30.00
per day; $51.00 (3 children) for the 5/23 half day or the Kindergarten
Minimum Day May dates: ___________________________________________________________ Please check the box if your Kindergartener will be
attending the 5/28 Minimum 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