Your School Year Care Registration Package has a total of 5 Forms
Please Read all information carefully!
All the forms are Editable PDF Forms 
that make it easy to fill out.
Just TAB through the document - TYPE in your information - then PRINT.
It's just that easy!
Directions on how to use Editable PDF forms are provided on the Instructions Page of each document.
For Ease of Printing
The following 5 forms should be downloaded to your computer!
(Right Click, Save to Disk)
You can now SAVE the information you type in the forms for future use.
You will need Adobe Reader version 7 or version 8.
Click: Why should I upgrade to Adobe Reader 8?
You will need Adobe Reader to open these files.
All 5 Enrollment Forms are REQUIRED to be TYPED.
*All 5 Forms MUST be submitted to the office
or your child WILL NOT BE ENROLLED!
1 - Registration Schedule Payment Agreement - Required
2 - Parental Consent & Emergency Contact Form - Required
3 - Expectations Checklist - Required
4 - Minor Media Release Form - Required
5 - Child Health Assessment Form - Required (your doctor completes this form)
NOTE: If you are new to the program or we do not have a valid Child Health Assessment Form on file (valid for one year), you and your doctor must complete this form prior to your child participating in the School Year Program. This is a requirement of the Pennsylvania Department of Public Welfare.
A copy of your signed Registration Schedule Payment Agreement will be sent back to you. We will fill in your weekly fee based upon your schedule selections.
Due to DPW site capacity limitations our enrollment process has always been a first come, first served basis at our sites. So please, send in your enrollment forms as soon as possible.
Mail all 5 forms along with your registration fee to:
Mt. Lebanon Extended Day Program
250 Mt. Lebanon Blvd.
Suite 414
Pittsburgh, PA 15234
