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SCCS Extended Care Registration 2026-27

Child Medical Information:
Please fill out completely. Enter “NA” if a question does not apply.
Significant illnesses and surgeries child has had (give age at time): *
Please share special health-related needs of child:
Food Allergies/Intolerances *
Medical Allergies *
Other Allergies *
Medical Conditions/Injuries *
Is there any defect of vision, hearing, or speech of which we should be aware, or could compensate by appropriate action? *
Is this child subject to any conditions which limit classroom activities or physical education? *
Is this child subject to any condition which may result in an emergency situation? *
Is this child subject to any mental or physical condition for which he/she should remain under periodic medical observation? *
Additional information you would like us to know about this child:
Immunization or exemption information concerning this child has been provided and is available in the SCCS file. * (1 required)
Yes No (your child will be put in a waiting pool until we receive the required records.)
If we don't have this child's immunization or exemption records yet, they may be sent to SCCS: sccsoffice@siouxcenterchristian.com

Emergency Contacts:
We require TWO emergency contacts who are NOT parents or guardians.
Emergency Contact 1: Full Name *
Emergency Contact 1: Relationship *
Emergency Contact 1: Phone (use format ###-###-####) *
Emergency Contact 2: Full Name *
Emergency Contact 2: Relationship *
Emergency Contact 2: Phone (###-###-####) *
Medical Providers:
Please completely fill in the addresses for doctor, dentist, and other medical professionals - HHS requires that we have the COMPLETE ADDRESS.
Child's Primary Doctor: Full Name *
Child's Primary Doctor: Phone (###-###-####) *
Child's Primary Doctor: Business Address *
Address 1
Address 2

City

State

Zip
Child's Primary Dentist: Full Name *
Child's Primary Dentist: Phone (###-###-####) *
Child's Primary Doctor: Business Address *
Address 1
Address 2

City

State

Zip
Other Medical Professional (who may need to be contacted in an emergency): Full Name
Other Medical Professional: Phone (###-###-####)
Other Medical Professional: Business Address
Address 1
Address 2

City

State

Zip

Family Information:
Primary Enrollment Parent/Guardian: Full Name *
Primary Enrollment Parent: Full Address (if different than child) *
Address 1
Address 2

City

State

Zip
Primary Enrollment Parent: Mobile Phone (###-###-####) *
Primary Enrollment Parent: Home Phone (###-###-####) *
Primary Enrollment Parent: Place of Employment *
Primary Enrollment Parent: Work Phone (###-###-####) *
Primary Enrollment Parent: Email you check regularly *
Secondary Enrollment Parent/Guardian: Full Name *
Secondary Enrollment Parent/Guardian: Address (if different than child) *
Address 1
Address 2

City

State

Zip
Secondary Enrollment Parent/Guardian: Mobile (###-###-####) *
Secondary Enrollment Parent/Guardian: Home Phone (###-###-####) *
Secondary Enrollment Parent: Place of Employment *
Secondary Enrollment Parent: Work Phone (###-###-####) *
Secondary Enrollment Parent: Email you check regularly *

Permissions and Signature:
I attest that the information on this form is accurate and up to date to the best of my knowledge. * (1 required)
Yes
In the event of an emergency (accident, illness, health or dental), I give my permission to the program staff to have my child treated by medical personnel. * (1 required)
Yes
In the event of an emergency, a staff member in charge shall make reasonable attempts to call me prior to and during emergency medical treatment.
I give permission for my child to travel in school vehicles or walk to off-campus sites during program activities. * (1 required)
Yes
I understand that if my child displays unacceptable behavior during the program, it may result in time away from the program. * (1 required)
Yes
I will not hold any program staff or staff of Sioux Center Christian School liable in the case of accident and/or injury. * (1 required)
Yes
This health and family information form must be completed annually for each child who participates in any of our extended care programs.
Typing my name in this box represents my signature and indicates that all the information entered in this form is accurate. *
Today's date: *

4Care Registration
Please choose the 4Care options below for this child.
A child must be 4 years old by Sept. 15, 2026 to enroll in 4Care.
4Care Session for this child
4Care | Morning Session (8am-12:00pm) | $3,675 4Care | Afternoon Session (11:30am-3:05pm, 2:05pm on Wed) | $3,675
August Extension: Tues, Aug 25 - Thurs, Aug 27 | $235
Yes No
May Extension: Mon, May 17 - Thurs, May 20 | $235
Yes No
Note: Hot Lunch is available for 4Care students and it is assumed they will be eating hot lunch unless you let us know (in August).
Hot Lunch will be paid through Automatic Withdrawal.
The final per meal price and applications for free and reduced meals will be available this summer.
Note: If you receive confirmation that your child has a spot in 4Care, you will also be sent a link on April 1, 2026, to register this child to attend Sioux Center Christian School.
You must complete the SCCS online registration to fully confirm this child's enrollment in 4Care at SCCS.
This page is blank since you did not choose to sign up for 4Care.
(note: on your email confirmation, there may be blank 4Care fields)
Click Next to continue.

Aftercare Student Schedule
Please indicate the days your child will regularly attend Aftercare. This helps us accurately check students in and out, and know when to follow up if a child is absent on an expected day or present on an unexpected day.
Days this child will be REGULARLY attending Aftercare:
Monday Tuesday Wednesday Thursday Friday
I understand that it is my responsibility to notify the Aftercare Staff (aftercare@siouxcenterchristian.com):
- if my child will NOT be attending on the regular days that I have indicated above
- if I plan for my child to attend on a day that is NOT indicated above
- regarding any unique pick-up circumstances or people NOT listed in the above names
I understand that Bloomz is the primary source of information regarding Aftercare updates, announcements, and closures.
(New SCCS parents - a Bloomz app invitation will be sent to you by the beginning of August)
I understand and agree to the statements above
Yes
This page is blank since you did not choose to sign up for Aftercare.
(note: on your email confirmation, there may be blank Aftercare fields)
Click Next to continue.

Sioux Center Christian School

Extended Care Sign up and Annual Health and Family Information Form

Extended Care Options:

Child Medical Information:

Please share special health-related needs of child:

Child Safety Information:

Emergency Contacts:

Medical Providers:

Family Information:

Permissions and Signature:

Tales and Trails Summer Camp Registration

This page is blank since you did not choose Tales & Trails Summer Camp.
(note: on your email confirmation, there may be blank Tales & Trails fields)

Click Next to continue.

4Care Registration

Please choose the 4Care options below for this child.

A child must be 4 years old by Sept. 15, 2026 to enroll in 4Care.

Note: Hot Lunch is available for 4Care students and it is assumed they will be eating hot lunch unless you let us know (in August).
Hot Lunch will be paid through Automatic Withdrawal.

The final per meal price and applications for free and reduced meals will be available this summer.

Note: If you receive confirmation that your child has a spot in 4Care, you will also be sent a link on April 1, 2026, to register this child to attend Sioux Center Christian School.
You must complete the SCCS online registration to fully confirm this child's enrollment in 4Care at SCCS.

This page is blank since you did not choose to sign up for 4Care.
(note: on your email confirmation, there may be blank 4Care fields)
Click Next to continue.

Aftercare Student Schedule

Please indicate the days your child will regularly attend Aftercare. This helps us accurately check students in and out, and know when to follow up if a child is absent on an expected day or present on an unexpected day.

I understand that it is my responsibility to notify the Aftercare Staff (aftercare@siouxcenterchristian.com):

if my child will NOT be attending on the regular days that I have indicated above

if I plan for my child to attend on a day that is NOT indicated above

regarding any unique pick-up circumstances or people NOT listed in the above names

I understand that Bloomz is the primary source of information regarding Aftercare updates, announcements, and closures.
(New SCCS parents - a Bloomz app invitation will be sent to you by the beginning of August)

This page is blank since you did not choose to sign up for Aftercare.
(note: on your email confirmation, there may be blank Aftercare fields)
Click Next to continue.

Thank you for registering for SCCS Extended Care!

You will receive a copy of your answers to the email provided below.

When you click Submit, you will be directed to a web page with additional Automatic Withdrawal information.

Thank you for entrusting your child to the care of our amazing faculty and staff!

Sioux Center Christian School
712.722.0777

sccsoffice@siouxcenterchristian.com

SCCS Online Forms

Sioux Center Christian School

Extended Care Sign up and Annual Health and Family Information Form

Extended Care Options:

Child Medical Information:

Please share special health-related needs of child:

Child Safety Information:

Emergency Contacts:

Medical Providers:

Family Information:

Permissions and Signature:

Tales and Trails Summer Camp Registration

This page is blank since you did not choose Tales & Trails Summer Camp.(note: on your email confirmation, there may be blank Tales & Trails fields)

Click Next to continue.

4Care Registration

Please choose the 4Care options below for this child.

A child must be 4 years old by Sept. 15, 2026 to enroll in 4Care.

Note: Hot Lunch is available for 4Care students and it is assumed they will be eating hot lunch unless you let us know (in August).Hot Lunch will be paid through Automatic Withdrawal.

The final per meal price and applications for free and reduced meals will be available this summer.

Note: If you receive confirmation that your child has a spot in 4Care, you will also be sent a link on April 1, 2026, to register this child to attend Sioux Center Christian School. You must complete the SCCS online registration to fully confirm this child's enrollment in 4Care at SCCS.

This page is blank since you did not choose to sign up for 4Care.(note: on your email confirmation, there may be blank 4Care fields)Click Next to continue.

Aftercare Student Schedule

Please indicate the days your child will regularly attend Aftercare. This helps us accurately check students in and out, and know when to follow up if a child is absent on an expected day or present on an unexpected day.

I understand that it is my responsibility to notify the Aftercare Staff (aftercare@siouxcenterchristian.com):

if my child will NOT be attending on the regular days that I have indicated above

if I plan for my child to attend on a day that is NOT indicated above

regarding any unique pick-up circumstances or people NOT listed in the above names

I understand that Bloomz is the primary source of information regarding Aftercare updates, announcements, and closures.(New SCCS parents - a Bloomz app invitation will be sent to you by the beginning of August)

This page is blank since you did not choose to sign up for Aftercare.(note: on your email confirmation, there may be blank Aftercare fields)Click Next to continue.

Thank you for registering for SCCS Extended Care!

You will receive a copy of your answers to the email provided below.

When you click Submit, you will be directed to a web page with additional Automatic Withdrawal information.

Thank you for entrusting your child to the care of our amazing faculty and staff!

Sioux Center Christian School712.722.0777

sccsoffice@siouxcenterchristian.com

This page is blank since you did not choose Tales & Trails Summer Camp.
(note: on your email confirmation, there may be blank Tales & Trails fields)

Note: Hot Lunch is available for 4Care students and it is assumed they will be eating hot lunch unless you let us know (in August).
Hot Lunch will be paid through Automatic Withdrawal.

Note: If you receive confirmation that your child has a spot in 4Care, you will also be sent a link on April 1, 2026, to register this child to attend Sioux Center Christian School.
You must complete the SCCS online registration to fully confirm this child's enrollment in 4Care at SCCS.

This page is blank since you did not choose to sign up for 4Care.
(note: on your email confirmation, there may be blank 4Care fields)
Click Next to continue.

I understand that Bloomz is the primary source of information regarding Aftercare updates, announcements, and closures.
(New SCCS parents - a Bloomz app invitation will be sent to you by the beginning of August)

This page is blank since you did not choose to sign up for Aftercare.
(note: on your email confirmation, there may be blank Aftercare fields)
Click Next to continue.

Sioux Center Christian School
712.722.0777