2023-2024 KED Family Registration Form

Registration is made on a space-available basis. Mustard Seed Community Childcare at Our Savior strives to provide care to all children without discrimination, accomodating all who can function safely and appropriately within the structure of the program and curriculum. Upon reciept by MSCCOS of the completed Registration Form, signed Enrollment Agreement and Registration Fee, the family is obligated to all MSCCOS financial and other policies.

KED Family Registration Form

Sex

Kindergarten Extended Day (KED) - first come, first served enrollment, with limited spaces available

Check here to give authorization for MSCCOS to discuss my child’s needs with Haddonfield school and Child Study Team personnel.

By checking the box below, you are agreeing to all financial responsibility:

Custody: If parents are divorced or separated, and/or the child is the subject of a court order, a certified copy (signed by a judge) of the most current document must accompany this form. If applicable, please indicate the court ordered custodial arrangement:

Does non-custodial parent have the right to visit the program site or take the child from the program site?

13 + 3 =

*MSCCOS needs two authorized emergency contacts other than parents.  Contacts must be at least 18 years of age. These individuals must be able to drive and be able to take your child in case of parent unavailability, and be within 15-20 minutes of the program. You may list as many additional persons (adults) authorized to pick up your child as you wish.  You may submit a signed additional sheet if necessary.  Under no circumstances will a child be released to any other person without prior authorization by parent.

For More Information

Please contact: Donna Marie Clancy, Executive Director

Or call: 856-669-4491