Middle School ASP

Junior High After School Program- Parent/Child Agreement

Please review this agreement with your child.

Keep this page for your records.

Hours: Program follows Bayfield school district calendar, with few exceptions. 6th-8th..............4:00-6:00-meets upstairs

(HS youth group begins at 6:30 - separate form required)

Dinner: 6th-12th at 5:45-6:15. Dinner opens for the public at 5:30 and is served until 6:15. Please feel free to join us for a FREE meal.

Dismissal: Parents are responsible for their child's ride home. Classes end promptly at 6:00pm

Classes: Adult classes are offered throughout the school year starting at 6:30pm. Childcare is available to those parents attending small group class sessions during this time. Advance notice not required, but it is appreciated. Please do not drop kids off early.

Dates: 2025-2026 Calendar of Events (emails and fliers may be sent home for more information)

September 3 - After School Program (ASP) Begins
October 15 - No After School Program (ASP)
November 19 - Thanksgiving Dinner & Christmas Program
November 26 - No After School Program (Thanksgiving Break)
December 17 - December 31 - No ASP (Christmas Break)
March 18 - No After School Program (Spring Break)
May 20 - Last day of After School Program

Expectations: While in our care children are required to:

  *Be respectful of everyone
*Being respectful and listening to those who are given a platform to
speak.
  *Adhering to a modest dress code (This includes: No Crop tops, low
cut shirts, short shorts, spandex. Dress code decisions ultimately lie with
youth pastors or church leadership).
  *No foul language
  *No purple! So, no holding hands, kissing, or cuddling with the opposite
or same gender
  *No use of Alcohol, drugs, or Nicotine products on church premises
  *No engaging in sexual activities with any children, youth, or adults
  *Refrain from participating in gossip, hurtful conversation
  *Appropriate use of phones, and social media (Such as not posting or
sending inappropriate photos of yourself or others)
*While at youth group youth are required to participate in all activities
unless Andy or Anna are notified by parents, doctor's note, or through
this form
  *Abide by rules. (Suspension from school bus is a suspension from After School Program)

****Once your child is on Pine Valley Foursquare Church property, for the purpose of attending youth group or youth event, they ARE NOT allowed to leave the church property unless parents have communicated with Andy or Anna before the time your child is trying to leave. Even if your student is able to drive his or herself to and from Youth Group, parent contact must be made with Andy or Anna. Students who are of 18 years of age but still attending high school and youth group must abide by the same rules****

Consequences of Failure to comply with behavior requirements:

*Time out from activities as a warning about suspension if needed.

*Two-week suspension; upon return to ASP, child will present a written apology signed by child and parent, OR a consequence to be determined by the pastor.

*Parents will be contacted immediately if their child leaves the premises without authorization. If PVC is unable to reach the parent, we will call the emergency contact listed. If neither party is available, we will contact local authorities. Your child's safety is extremely important.

By enrolling in the program. and signing the agreement, you and your child/ren are acknowledging agreement with rules and expectations stated here and in compliance with PVC bus and school district bus rules where applicable.

ALL CHILDREN MUST BE ENROLLED IN ASP PRIOR TO ATTENDING!

Pine Valley Church After School Program Participant Permission Slip

To enroll your ASP participants, please return this page along with bus permission form (Link on Youth Page) to: Pine Valley Church, Attn: Youth Ministry

Please use one of the following options to return forms:

I. Drop-Off: 1328 County Rd. 501. Youth Room.
2. Mail: PO Box 740, Bayfield CO. 81122
3. Email: (K-5th) jill@pvc4sq.org, (6th-12th) andy@pvc4sq.org, anna@pvc4sq.org

(You may enroll up to four children per page, K-5 OR 6-12. Please fill out separate forms outside of these groupings)

1. Childs Name*

Male or Female*

MaleFemale

Grade*

Age*

Date of Birth*

2. Childs Name

Male or Female

MaleFemale

Grade

Age

Date of Birth

3. Childs Name

Male or Female

MaleFemale

Grade

Age

Date of Birth

Date

4. Childs Name

Male or Female

MaleFemale

Grade

Age

Date of Birth

Parent printed name*

Phone (Primary)*

Phone (Secondary)

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact (Not a parent):

Name*

Phone*

*If your child has special medical, nutritional, or behavioral needs, or legal issues in place, please see Jill or Andy for accommodation options.

Where did you hear about our program?

By signing below. I am acknowledging that I have read the expectations to my child/ren, and that we understand the information stated in the Middle School Youth Group Program Parent/Child Agreement. We agree to the terms of expectations at PVC, and on the bus that transports them to the church. In addition,I understand that PVC often uses multiple media outlets to promote events. celebrate achievements, etc. By signing below, I give permission to Pine Valley Foursquare Church to use my child/ren's images for church related uses, including but not limited to video, print and audio outlets. Please note, our facility is equipped with surveillance equipment. and in turn. the goings-on of the facility will be recorded for the safety and protection of all those on church property. Parent Signature:Date:

Date*

Date

Signature*

Youth Information

Parent Information