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An Opportunity To Learn Hands On! When registering with LE3 youre 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 LE 3 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.

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

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Text of St. Benedict’s Presents A NEW Extended Day Academic ... · ☐Yes ☐ ☐ ☐ ☐Yes ☐ ☐...

  • 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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    ☐ Ma ☐

    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:

    Relationship to Child: Primary Phone Number: ( ) -

    In case of an Emergency Contact: Yes No

    Name:

    Relationship to Child: Primary Phone Number: ( ) -

    In case of an Emergency Contact: Yes No

    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

  • ☐ ☐ ☐

    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

  • SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

    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

    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.

    November Calendar Is Due October 1.

    December Calendar Is Due November 1.

    Columbus Day

  • SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

    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

    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.

    December Is Due On November 1.

    January Is Due On December 1.

    Thanksgiving Break

    Thanksgiving Break

    Winter Break

  • SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

    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

    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.

    January Calendar Is Due December 1.

    February Calendar Is Due January 1.

    Winter Break

    Winter Break

    Winter Break

    Winter Break

    Winter Break

  • SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

    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

    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.

    February Calendar Is Due January 1.

    March Calendar Is Due February 1.

    Winter Break

  • SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

    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

    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

    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 MARCH 2017

    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.

    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

  • SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

    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

    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

    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

    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.

    April Calendar Is Due February 1.

    May Calendar Is Due April 1.

  • SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

    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

    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

    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.

    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

  • SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

    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

    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.

    June Calendar Is Due May 1.

    Memorial Day

  • SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

    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

    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

    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.

    Breakfast & Snack Included In Fee!Low Prices!Child’s Name:Age:Please attached your child’s physical, medical information, and doctor’s information.My Child Needs Academic Guidance in:My child can be in pictures or videos of activities taking place during program hours:Parent/Guardian Name:Parent/Guardian Name:Name:

    Adding Un-Contracted DaysBinder1.pdfSeptemberOctoberNovemberDecemberJanuaryFebruaryMarchAprilMayJune

    Childs Name: Date of Birth: undefined: undefined_2: Age: Ma: OffFemale: OffSchool: Grade: undefined_3: undefined_4: Address: City: Sate: Zip Code: Please attached your childs physical medical information and doctors information 1: Please attached your childs physical medical information and doctors information 2: Please attached your childs physical medical information and doctors information 3: Math: OffScience: OffHistory: OffELA: OffReading: OffWriting: OffTechnology: OffOrganizational Skills: OffStudy Skills: OffOther: Offundefined_5: While at program my child needs to complete their homework rather than waiting until they: OffMy child may play on the playground and gym equipment with supervision: OffMy child can be in pictures or videos of activities taking place during program hours: OffParentGuardian Name: Relationship to Child: Email: Primary Phone Number: undefined_6: undefined_7: Secondary Phone Number: undefined_8: undefined_9: ParentGuardian Name_2: Relationship to Child_2: Email_2: Primary Phone Number_2: undefined_10: undefined_11: Secondary Phone Number_2: undefined_12: undefined_13: Name: Relationship to Child_3: Primary Phone Number_3: undefined_14: undefined_15: In case of an Emergency Contact: OffName_2: Relationship to Child_4: Primary Phone Number_4: undefined_16: undefined_17: Yes_5: OffNo_5: OffName_3: Relationship to Child_5: Primary Phone Number_5: undefined_18: undefined_19: In case of an Emergency Contact_2: OffPlease 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 weektoweek 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 UnContracted Days Please note if you would like to add days throughout the week in addition to your contracted schedule youre welcome do so under the uncontracted rate To add days o Contact the LE3 office via phone or email with the days you would like to add o For any additional days added you will be charged the Uncontracted rate Contracted Days: not need to utilize the program: OffTuesday: MondayAfter School: Wednesday: Thursday: Friday: Charge my credit card on the 15th of each month for the upcoming registration My child will be: OffVisa: OffMaster Card: OffAmerican Express: OffName on Credit Card: Credit Card Number: undefined_20: Security Code: Billing Address: State: Zip Code_2: Send me an Invoice with the option to pay online with a credit card bank transfer and or: OffI will bring cash to the program manager with a copy of my invoice each month: OffLabor Day: Text1: Columbus Day: Thanksgiving Break: Thanksgiving Break_2: Text2: Presidents Day: