St. Benedict’s Presents A NEW Extended Day Academic ... · ☐Yes ☐ ☐ ☐ ☐Yes ☐ ☐ ☐Math ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Ma ☐ LE. 3 . Child Registration Form

An Opportunity To Learn Hands On! When registering with LE3 you’re signing up for a unique, academic, and safe after school program!

Breakfast & Snack Included In Fee!

Late Pick Up: 6:00pm

Weekly Character Building Lessons!

Low Prices!

Full Day Camps On Days Off Of School! (Lunch Included In

Fee)

Special Program Options:

• Homework Help• One-on-One Tutoring ( Subject Specific)• A Unique Hands On Curriculum• Quiet Reading Time• Athletics• Arts• Group Reading• Instruction Via Technology

LE3 INC 25 California Drive Williamsville, NY

14221

www.le3-inc.org

[email protected] 716-430-9322

LE3 Inc. Locally Enriching Educational Experiences

For All Children Via After School Academic Programming.

St. Benedict’s Presents A NEW Extended Day Academic

Program Hosted By LE3 INC.

http://www.le3-inc.org/

mailto:[email protected]

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LE3 Child Registration Form 2016-2017 School Year

Child’s Name:

Date of Birth: / / Age: Gender: Male Female

School: Grade:

Address:

City: Sate: Zip Code:

Special Health Care Needs: Please list any allergies, medications, or educational needs that

your child has that may impact their experience.

Please attached your child’s physical, medical information, and doctor’s information.

My Child Needs Academic Guidance in:

Math Science History ELA

Reading Writing Technology Organizational Skills

Study Skills Other:

While at program, my child needs to complete their homework rather than waiting until they

get home: Yes No Does Not Matter

My child may play on the playground and gym equipment with supervision:

Yes No

My child can be in pictures or videos of activities taking place during program hours:

Yes No

Child

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Parent/Guardian Name:

Relationship to Child: E-mail:

Primary Phone Number: ( ) - Secondary Phone Number: ( ) -

Parent/Guardian Name:

Relationship to Child: E-mail:

Primary Phone Number: ( ) - Secondary Phone Number: ( ) -

My child can be picked up by the following parent/guardians:

Name:

Relationship to Child: Primary Phone Number: ( ) -

In case of an Emergency Contact: Yes No

Name:



Name:



Parent/Guardian Information

Emergency Contact Information

Please just keep my information of file in case of an emergency. I do not need to utilize the program. Place an X in the days that you would like your child to attend LE3. By marking off days below

you are agreeing to a contracted payment plan. If your child will not be attending LE3 on any

scheduled day please notify the school and LE3.

Monday Tuesday Wednesday Thursday Friday

After School

**If your schedule changes week-to-week please complete the attached calendars and return at least

September with your registration form. Each calendar needs to be returned to the Director of the

program by the first of the previous month. For Example: October is due on September 1st.**

Adding Un-Contracted Days

Please note: if you would like to add day’s throughout the week in addition to your

contracted schedule you’re welcome do so under the uncontracted rate.

To add days:

o Contact the LE3 office via phone or e-mail with the days you would like to add.o For any additional days added you will be charged the Un-contracted rate.

Contracted Days

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Contracted Option Uncontracted Option 1 Child: $6.00 / Hour 1 Child: $7.50 / Hour

2 Children: $7.00 / Hour / Child 2 Child: $8.50 / Hour 3+ Children: $8.00 / Hour / Child 3+ Children: $9.50 / Hour

** Pre-K 3&4 children who come down at 2:45 will be charged an additional $2.50 for the added time. This is a daily fee**

Option 1:

Charge my credit card on the 15th of each month for the upcoming registration. My child will be

attending the same days each week and each month. I would like automatic payments.

Visa Master Card American Express

Name on Credit Card:

Credit Card Number:

Expiration Date: ____ /_____ Security Code: _

Billing Address: State: Zip Code:

Option 2:

Send me an Invoice with the option to pay online with a credit card, bank transfer, and or money order.

Option 3:

I will bring cash to the program manager with a copy of my invoice each month.

Signature of Parent/Guardian: __________________________ Date: ______________________

*Please complete and return to LE3 at:E-mail: [email protected]

Mail: 25 California Drive Williamsville, NY 14221

OR

Return to the St. Benedict’s School Main Office to Be Placed in the LE3 Mail Box. Please specify and/or label the front of an envelope designated the packet for LE3.

Payment Options

mailto:[email protected]

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

1 2 3

4 5 6 7 8 9 10

11 1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22

SEPTEMBER 2016

1 2 3 4 5 6 7 8 9 10 11 12 13

14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

AUGUST 2016 OCTOBER 2016

NOTES:

Any Days Marked Off With An “X” Will Be

Considered Contracted Days.

Please Turn In Calander On The First Of Each

Month To Register For The Upcoming Month.

October Calendar Is Due September 1.

November Calendar Is Due October 1.

Labor Day


1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

OCTOBER 2016

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

1 2 3 4 5 6 7 8 9 10 11 12

13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

SEPTEMBER 2016 NOVEMBER 2016

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November Calendar Is Due October 1.

December Calendar Is Due November 1.

Columbus Day


1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23

24 25 26

27 28 29 30

NOVEMBER 2016

1 2 3 4 5 6 7 8 9 10 11 12 13 14

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

OCTOBER 2016 DECEMBER 2016

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December Is Due On November 1.

January Is Due On December 1.

Thanksgiving Break

Thanksgiving Break

Winter Break


1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

DECEMBER 2016

1 2 3 4 5 6 7 8 9 10 11 12

13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

1 2 3 4 5 6 7 8 9 10 11 12 13 14

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

NOVEMBER 2016 JANUARY 2017

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January Calendar Is Due December 1.

February Calendar Is Due January 1.

Winter Break

Winter Break

Winter Break

Winter Break

Winter Break


1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

JANUARY 2017

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

DECEMBER 2016 FEBRUARY 2017

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February Calendar Is Due January 1.

March Calendar Is Due February 1.

Winter Break


1 2 3 4

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12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28

FEBRUARY 2017

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

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5 6 7 8 9 10 11

12 13 14 15 16 17 18

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26 27 28 29 30 31

JANUARY 2017 MARCH 2017

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March Calendar Is Due February 1.

April Calendar Is Due on Fbruary 1.

March Calendar is due February 1.

December Calander is Due November 1.

President’s Day

Mid-Winter Break

Mid-Winter Break

Mid-Winter Break

Mid-Winter Break


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26 27 28 29 30 31

MARCH 2017

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12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

FEBRUARY 2017 APRIL 2017

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April Calendar Is Due February 1.

May Calendar Is Due April 1.


1

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23 24 25 26 27 28 29

30

APRIL 2017

1 2 3 4 5 6 7 8 9 10 11

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13

14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

MARCH 2017 MAY 2017

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May Calendar Is Due April 1.

June Calendar Is Due on May 1.

Spring Break

Spring Break

Spring Break

Spring Break

Spring Break

Spring Break


1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

MAY 2017

1 2 3 4 5 6 7 8 9 10 11 12 13 14

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

1 2 3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

APRIL 2017 JUNE 2017

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June Calendar Is Due May 1.

Memorial Day


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18 19 20 21 22 23 24

25 26 27 28 29 30

JUNE 2017

1 2 3 4 5 6 7 8 9 10 11 12 13

14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

MAY 2017 JULY 2017

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Documents

St. Benedict’s Presents A NEW Extended Day Academic ... · ☐Yes ☐ ☐ ☐ ☐Yes ☐ ☐ ☐Math ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Ma ☐ LE. 3 . Child Registration Form