📚 Extended Care Application

📚 Application for Extended Care Program 📚

We are excited to offer care for children ages 3–12 years on every school day. Please complete the following form to submit a registration request for your child for the 2026-2027 school year.

Student's First Name

Student's Last Name

Student's Gender

Male

Female

Student's Birthdate

Student's Address

First Name Parent/Guardian #1

Last Name Parent/Guardian #1

Parent/Guardian #1 Relationship to Child

Father

Mother

Grandparent

Legal Guardian

Email Address Parent/Guardian #1

Phone Number Parent/Guardian #1

First Name Parent/Guardian #2

Last Name Parent/Guardian #2

Parent/Guardian #2 Relationship to Child

Father

Mother

Grandparent

Legal Guardian

Email Address Parent/Guardian #2

Phone Number Parent/Guardian #2

What made you choose Faith Lutheran's Extended Care program?

When would you like your child to start?

When school starts this Fall.

I would like my child to start now.

Transportation is available to and from Southside Elementary. Please indicate below whether your child will utilize bus service and select the applicable option(s).

Not Applicable

7 - 7:30 AM: Bus pick up to Southside

3 - 5:30 PM: Bus drop-off from Southside

Registered Unlicensed Ministry Parent/Guardian Notice

I understand that this child care ministry is not licensed under the laws of the State of Indiana.

I further understand that this child care ministry complies with applicable state requirements regarding sanitation and fire safety for the primary use of the facility in which care is provided.

I acknowledge that it is my responsibility to ensure that the nutritional and health needs of my child are met while my child is attending this child care ministry.

I understand that this notice does not relieve the child care ministry of liability for injury to a child resulting from negligence or intentional misconduct on the part of the ministry or any of its employees.

I acknowledge that I have read and understand the information contained in the notice above.

Brightwheel Software Application Acknowledgement

Faith Lutheran has partnered with Brightwheel, a childcare management software platform with a mobile app that connects families to Faith Lutheran Child Care programs. This platform offers convenient features including online enrollment and re-enrollment, digital forms, secure messaging between teachers, parents, and office staff, photo and video sharing, easy online payment options, and access to year-end tax statements.

I agree to the terms and conditions associated with using this application and understand that Brightwheel is the primary means of communcation with Faith.

Please Type or Sign Your Signature Below

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Thank you for your interest in our Extended Care Program!

Once you submit this application, we will review your child's information and follow up with additional enrollment instructions.

If you have not received a response within two business days, please contact our office for assistance.

📚 Application for Extended Care Program 📚

We are excited to offer care for children ages 3–12 years on every school day. Please complete the following form to submit a registration request for your child for the 2026-2027 school year.

Student's First Name

Student's Gender

Male

Female

First Name Parent/Guardian #1

Last Name Parent/Guardian #1

Parent/Guardian #1 Relationship to Child

Father

Mother

Grandparent

Legal Guardian

Email Address Parent/Guardian #1

Phone Number Parent/Guardian #1

First Name Parent/Guardian #2

Last Name Parent/Guardian #2

Parent/Guardian #2 Relationship to Child

Father

Mother

Grandparent

Legal Guardian

Email Address Parent/Guardian #2

Phone Number Parent/Guardian #2

What made you choose Faith Lutheran's Extended Care program?

When would you like your child to start?

When school starts this Fall.

I would like my child to start now.

Transportation is available to and from Southside Elementary. Please indicate below whether your child will utilize bus service and select the applicable option(s).

Not Applicable

7 - 7:30 AM: Bus pick up to Southside

3 - 5:30 PM: Bus drop-off from Southside

Registered Unlicensed Ministry Parent/Guardian Notice

I understand that this child care ministry is not licensed under the laws of the State of Indiana.

I further understand that this child care ministry complies with applicable state requirements regarding sanitation and fire safety for the primary use of the facility in which care is provided.

I acknowledge that it is my responsibility to ensure that the nutritional and health needs of my child are met while my child is attending this child care ministry.

I acknowledge that I have read and understand the information contained in the notice above.

Brightwheel Software Application Acknowledgement

I agree to the terms and conditions associated with using this application and understand that Brightwheel is the primary means of communcation with Faith.

Please Type or Sign Your Signature Below

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Thank you for your interest in our Extended Care Program!

Once you submit this application, we will review your child's information and follow up with additional enrollment instructions.

If you have not received a response within two business days, please contact our office for assistance.