2017-18 Senior High Leadership 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.
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:
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.
While in our care students 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 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:
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?
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: 2017-18 Senior High Leadership Program Registration
Agree & Sign