2017-18 Junior High Afterschool Registration

Wednesday Afterschool Program

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.

6th – 8th Grade Hours: 3:40 to 6:30 p.m. (high school students serving as student leaders will also need to register)

Parent / Child Agreement


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.

  • We encourage parents to arrange transportation for their children. If parents are unable to provide transportation, they may choose to ride the designated church bus from school. The parent(s) must fill out the Bayfield School District Permission and Agreement for after-school transportation, authorizing their child to ride the bus and participate in the After-School Program. Do not return forms to the school. Pine Valley Church is not responsible for any child choosing to walk to the church.
  • Parents are responsible for their child’s ride home; classes end promptly at 6:30 p.m., at which time parents are expected to pick up their children. Children K to 5th grade must be signed out. 

While in our care children are required to:

  • Participate in group activities provided
  • Respect ALL leaders, peers and facility
  • Remain in designated areas (roaming the church building and/or property unaccompanied is not allowed)
  • Complete their homework before participating in activities
  • Abide by bus rules and bus drivers instructions
  • Cellphones are to be turned OFF during the program unless authorized by a leader. **Unauthorized cellphone use will result in confiscation and returned at end of evening.**

Consequences for failure to comply with behavior requirements:

  • Time out from program. Our leaders will sit down and talk with student one-on-one. 
  • Two-week suspension; upon return to program, they must return with a written apology signed by child and parent or a consequence to be determined by pastor.
  • Parents will be contacted immediately if their child departs the premises without authorization. If we are unable to reach the parent, we will call the emergency contact person. If neither party is available, we will contact the police department. Your child’s safety is extremely important!

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.

Pine Valley Church After-School Program Permission and Agreement

All children must be enrolled before attending the ASP.

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:

Parent / Guardian’s Full Name:

Street address:




Mailing address (if different):


Student’s phone number (if applicable):

  Can we add phone number to our student TXT group?

Student’s e-mail address (if applicable):

  Can we add student to our email newsletter?


Parent/Guardian phone number:

Parent’s email address:

  Can we add you to our student ministry email newsletter?




Date of Birth:  




Emergency contact (other than parent/guardian):

Emergency contact phone number:

May we use your child’s photograph for publication?


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:


(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:

Pine Valley Church https://pinevalleychurch.org
Signature Certificate
Document name: 2017-18 Junior High Afterschool Registration
Unique Document ID: 11b25cac01b224ac81f1732b0ea91fea52c8d96a
Timestamp Audit
July 28, 2017 6:40 pm MST2017-18 Junior High Afterschool Registration Uploaded by Denise L Martin Martin - diamondm@frontier.net IP