Request for C.R.E.W. Program (After School Program)
Thank you for your interest in the Horizon Academy West CREW program. Due to limited space in each cohort, we will be using this survey to hold your place in line. Please fill one form out per child. Please visit
for application and additional information. Contact Mrs. Jennifer Lacey, CREW Manager, with any questions at
Student's Last Name
Student's First Name
Current Grade level
Last Name of Child's Teacher:
I am interested in:
CREW two-day after school program only (Monthly payment $95.00)
CREW two-day after school program plus full day Friday (Monthly payment $ 150.00)
CREW full day Friday only (Monthly payment $ 90)
3. I understand this is a first-come, first-serve program, and there will be a maximum number of slots for each cohort day & Friday. This survey determines my place in line. If all the slots are full for my day, I will then be put on a waiting list.
4. I understand that all payments will be made through My School Bucks on the 10th of each month by 8:00 pm. and your 1st payment will be due upon enrolment.
My child is in cohort?
6. I understand that the program will follow all school reentry protocols and safety procedures & practices during this pandemic.
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