Extended Day Drop-In Request Form

Parents can submit a drop-in service request at least 24 hours in advance. Expect to receive an e-mail notification from the Extended Day office confirming your request.

The 2022–23 drop-in rate is $14/hour and payment is billed monthly from Student Billing. For questions, please call Elise Ernette at (704) 943-4964 or e-mail elise.ernette@charlottecountryday.org.

Student Information

Student Namerequired

First Name

Last Name

Student IDrequired

Student ID can be found on your ID card or the top of your billing statement.

Graderequired

Classroom Teacherrequired

Your Information

Parent Namerequired

First Name

Last Name

E-mailrequired

Cell Phonerequired

Are you faculty/staff?

Yes

No

Drop-In Information

Do you have an ongoing Extended Day contract?required

Yes

No

What time do you typically pick up your child?required

Requested Care

One Day Only

Must contain a date in M/D/YYYY format

Pick-up Timerequired

(please indicate time between 2-6 pm in half hour increments)

Multiple Days

(Please list actual dates--i.e. October 4, 5, 8)

Pick-up Time

(please indicate time between 2-6 pm in half hour increments)

Name of person picking up your child

Special Instructions

Include any additional information you think would be helpful for us to know.

Carpool Information

Is your student being picked up in a grade level carpool?required

Yes

No

Who is your student carpooling with?required

Grade and classroom teacher of student carpooling withrequired