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2017-18 Senior High Leadership Program Registration

Wednesday Senior High Leadership 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.

High school students need to arrive at Pine Valley right after school to check in with the Program Director and get instruction and/or assignments for the day.

The leadership program is for students who are committed to serve and minister at our Wednesday evening Afterschool Program for elementary through junior high students. They will be on-site and serving as student leaders and under the supervision and mentorship of our Leadership Program Director.

There are several areas available to serve in:

Registration
Snack shack
Media / audio (after training only)
Activities support
Junior staff / chaperones (serving under adult leaders) for both elementary and junior high students
Worship team
Stage ministry: prayer and speaking assignments

Parent / Student Agreement

PLEASE REVIEW WITH YOUR STUDENT

We are excited that you are interested in your senior high student serving through our Wednesday Afterschool Program! We consider it a privilege to serve the families of our community. While at the Wednesday Afterschool Program, your student will give assistance with elementary student’s homework, receive a free snack, participate in helping to lead games, activities, ministry and teaching, 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. Senior highers eat with the junior high students. Parents are welcome to join their children for dinner.

For your student’s safety, we have established a few guidelines to be followed.

We encourage parents to arrange transportation for their senior high students. If parents are unable to provide transportation, Pine Valley Church is not responsible for any student choosing to walk to the church.
Parents are responsible for their student’s ride home; classes end promptly at 6:30 p.m., at which time parents are expected to pick up their students. Children K to 5th grade must be signed out.

While in our care students 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)
Abide by and model all rules for the students they are serving
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 student and parent or a consequence to be determined by pastor.
Parents will be contacted immediately if their student 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 student’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 Afterschool Program Permission and Agreement

All students 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 and the senior high leadership program end promptly at 6:30 p.m.

Student’s Full Name:

Student has read and agrees to all program conditions as stated above

Parent / Guardian’s Full Name:

Street address:

City:

State:

Zip:

Mailing address (if different):

STUDENT CONTACT INFO

Student’s phone number (if applicable):

Can we add phone number to our student TXT group? Yes No

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

Can we add student to our email newsletter? Yes No

PARENT / GUARDIAN CONTACT INFO

Parent/Guardian phone number:

Parent’s email address:

Can we add you to our student ministry email newsletter?

STUDENT INFORMATION

School:

Grade:

Date of Birth:

Age:

Gender Male Female

ADDITIONAL INFORMATION

Emergency contact (other than parent/guardian):

Emergency contact phone number:

May we use your child’s photograph for publication? Yes No

Allergies:

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:

Pine Valley Church http://pinevalleychurch.org

Timestamp

Audit

2017-07-28 19:12:51 MDT

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