Editing previous response:

Please fix the highlighted areas below before submitting.

After School Program Fee

After School Program

We will be offering enrichment programs after school this year.

Each student must pay a $25 one time After School Program fee. In addition students are required to pay a fee for each program they participate in. Please see the website to pay for individual After School program registration fees.

Student Information

First Name*

Answer Required

Last Name*

Answer Required

Grade*

Answer Required

After School Program Selection*

Answer Required

Date of Birth*

Answer Required

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Parent Information

By completing this form I give permission for the above listed child to participate in the After School Activity Program for the 2022-23 School Year. I agree to the PACE AfterSchool Program Rules and Conduct Policy. I understand that if my student fails to comply with rules, procedures and or policies it may be grounds for dismissal from the program.

Parent / Guardian 1 First Name*

Answer Required

Parent / Guardian 1 Last Name*

Answer Required

Parent / Guardian 1 Email*

Answer Required

Parent / Guardian 1 Phone*

Number Required

Parent / Guardian 2 First Name

Answer Required

Parent / Guardian 2 Last Name

Answer Required

Parent / Guardian 2 Email

Answer Required

Parent / Guardian 2 Phone

Number Required

Who will be picking up your child?*

Answer Required

After School Program Fee

Required After School Program Fee

Price: $25.00

Confirmation Email

Confirmation Email *

Email Required