2016-17 Elementary Afterschool Program Registration
Program begins the first Wednesday school is in session. Program ends the third Wednesday in May.
With the exception of the start and finish days, the program follows the Bayfield School District calendar.
K – 5th Grade Hours: 3:30 to 6:30 p.m.6th – 8th Grade Hours: 3:40 to 6:30 p.m. (high school students serving as student leaders will also need to register)
We are excited that you are interested in our Wednesday After School Program! We consider it a privilege to serve the families of our community. While at the Wednesday After School Program, your children (grades K-8th, with some high schoolers also serving in our leadership program) will receive assistance with their homework, receive a free snack, participate in games and activities and are invited to stay for dinner ($1.00 suggested donation for the meal).
Mealtime is from 5:00 to 6:15 p.m. Children, K- 5th, eat at 4:45 p.m. and 6th to 8th graders at 5:15 p.m. Parents are welcome to join their children for dinner.
For your children’s safety, we have established a few guidelines to be followed.
While in our care children are required to:
Consequences for failure to comply with behavior requirements:
For further questions contact: The children’s or youth department @ (970) 884-7196
Bible classes are available for adults at 6:30 p.m.; childcare/classes will be available for students of adults attending classes.
By enrolling in the program and signing the below agreement, you are acknowledging agreement with the rules and expectations stated above. You are also acknowledging the pick-up times for your child(ren). All programs for K–8 end promptly at 6:30 p.m.
Child’s Full Name:
Child has read and agrees to all program conditions as stated above
Parent / Guardian’s Full Name:
Mailing address (if different):
PARENT / GUARDIAN CONTACT INFO
Parent/Guardian phone number:
Parent’s email address:
Date of Birth:
Gender Male Female
Emergency contact (other than parent/guardian):
Emergency contact phone number:
May we use your child’s photograph for publication? Yes No
Person #1, other than you, authorized to pick-up child:
Person #1’s phone number:
Additional person(s) authorized to pick up student (list full names and numbers):
Are you a: Pine Valley Church Member (have attended classes and signed the forms) Pine Valley Church Attendee Afterschool Program Participant
(Please complete a separate from for additional child(ren)
*** Will your child be riding the Bayfield School District bus (FREE) to the Afterschool Program? You will also need to fill out and sign the required Afterschool Bus Form to grant transportation permissions.
Leave this empty:
If you have questions about the contents of this document, you can email the document owner.
Document Name: 2016-17 Elementary Afterschool Program Registration
Agree & Sign