2018-19 After School Care Request Form
PVCICS offers 3 after school programs - these are not drop-in programs, all students must be enrolled for a minimum of 3 days per week. Families will be invoiced only once at the beginning of the year.

**After school is NOT provided on any early-release days, half days or vacation days.**

• To complete this year’s registration there must be no balance from the previous year’s after-school care.
• Payments must be made between 1st and 15th day of each month in advance to the Front Office.
• Please make checks payable to PVCICS
• Please include your child(ren)'s name and a note saying "After School Care" on the check.

If we do not receive payment before the 15th of the prior month, then the student will be withdrawn from the program. The student will not be re-enrolled into the program until payment is received. The after school program relies on fees to operate the program. Failure to make payment after multiple reminders, will result in no enrollment.

There will be no refund for any day(s) for which you have paid the fee, but your child(ren) did not attend. If you need to change your child(ren)'s enrollment status and/or schedule(i.e the days they attend after-school ; or if you're withdrawing from after-school), please send a written notice to the office.

Email address *
Student's Full Name *
First Name and Last Name
Your answer
Student's Grade *
Your answer
Primary Parent/Guardian Name *
Best ONE to contact
Your answer
Primary Parent/Guardian's Email *
A confirmation email will be sent to this address.
Your answer
Primary Parent/Guardian's Phone *
Best ONE to contact for emergency
Your answer
Your application cannot be processed unless this form is complete and payment is received. Submitting this form does not guarantee a slot. You will be notified by email when this application has been processed. *
Required
✦K-1 Bridge program 3:30pm-4:10pm
for Kindergarten and First grade students only ; Dismissal time for K and 1st is 3:30pm, the bridge program provides after care from 3:30pm-4:10pm
3 days/week $60/month
4 days/week $80/month
5 days/week $100/month
Bus
Monday
Tuesday
Wednesday
Thursday
Friday
✦K-1 Full program 3:30pm-5:30pm
for Kindergarten and First grade students Dismissal time for K and 1st is 3:30pm, the full after care option provides care from 3:30pm-5:30pm
3 days/week $160/month
4 days/week $200/month
5 days/week $240/month
Monday
Tuesday
Wednesday
Thursday
Friday
✦G2-8 After school program 4:15pm-5:30pm
for students in grades 2-8 ; Dismissal time for grades 2-8 is 4:15pm, after school care ends at 5:30pm.
3 days/week $120/month
4 days/week $150/month
5 days/week $180/month
Monday
Tuesday
Wednesday
Thursday
Friday
A copy of your responses will be emailed to the address you provided.
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