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Rochester Central Lutheran School


Clubhouse Registration


Clubhouse Registration: Grades PS-2

This Clubhouse school-day AND non-school-day registration is open to RCLS students in Grades PS-2 who need before- or after-school childcare.
Student #1 Namerequired
First Name
Last Name
Student #2 Name
First Name
Last Name
Student #3 Name
First Name
Last Name

So we may adequately staff Clubhouse, we need to be able to anticipate attendance numbers. Please indicate regular attendance days. If attendance days for morning or after-school care vary, please explain. Limited walk-in spots will be available.

Morning ClubrequiredOpen 6:30-8:10am​​
Open 6:30-8:10am​​
Family's Regular Morning Club Attendance Daysrequired
After-school ClubhouserequiredOpen 3-6​pm​​
Open 3-6​pm​​
Family's Regular Afternoon Attendance Days requiredPlease select up to 5 choices
Please select up to 5 choices
If your child's attendance days will vary by week or month, please explain.
Parent Namerequired
First Name
Last Name
Parent #2
First Name
Last Name

Emergency Contacts & Authorized Pickups: Please provide 2 contacts that live in the Rochester area.

Authorized Pickups: Additional persons authorized to pick up without permission.

Medical Information

Hospital Preference (check one)required

In case of an emergency, I authorize RCLS staff to obtain emergency service for my child, and I authorize appropriate qualified personnel to administer treatment.

Must contain a date in M/D/YYYY format

Payment Information

Provide an email address for the receipt.

Please complete captcha below to proceed to payment selection.

Please select a payment typerequired
Billing Addressrequired
Cardholder Namerequired