2014-2015 6th and 7th Grade Families

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* 1. How old will your child be in the beginning of the 2014-2015 school year?

11

12

13

Other (please specify)

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* 2. Please list any other children who will be attending Rolland-Warner in the 2014-2015 school year and their ages.

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* 3. Will your 6th or 7th grade child need before or after school child care for the 2014-2015 school year?

Yes

No

Other (please specify)

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* 4. If yes, specifically what do you estimate you will need for child care next year?

	Before School	After School	Both
Monday	Monday Before School	Monday After School	Monday Both
Tuesday	Tuesday Before School	Tuesday After School	Tuesday Both
Wednesday	Wednesday Before School	Wednesday After School	Wednesday Both
Thursday	Thursday Before School	Thursday After School	Thursday Both
Friday	Friday Before School	Friday After School	Friday Both

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* 5. If you believe you will need child care for your 6th or 7th grade child, please share your e-mail and phone number so we may be able reach you in the event that we are able to provide services.