After School Program Enrollment Form

After School Program Enrollment Form

2024-2025
Veritas Academy is pleased to offer our After School Program for those families that need care for their children beyond the normal school day.

Students will experience outdoor play and nature exploration on our 10 acre wooded campus, snack time, homework and reading/math practice as needed, indoor play, arts & crafts, and games.

2:40 pm to 6pm - With School Pick Up - Snack Included

Days must be prearranged

Weekly rates:

1 day $30

2 days $45

3 days $65

4 days $80

5 days $90

A 10% discount will be given for each sibling also participating.

Please complete and submit one form per student being enrolled in the After School Program.
Student's Name*

First NameLast Name
Grade in Fall 2024*

KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6
School Attending
Indicate the day(s) that you anticipate utilizing the After School Program:*

MondayTuesdayWednesdayThursdayFriday
School Holidays Options

Outdoor and indoor play, science experiments, arts and crafts, quiet activities, reading time, math games, etc.

Daily Rates:

8am to 3pm - $45 per day
7am to 6pm - $60 per day
Do you expect to need care during school holidays?*

YesNo
Please note any known allergies or special needs:
Parent's Name*

First NameLast Name
Parent's Phone Number*

Area CodePhone Number
Parent's Email*
Emergency Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Please specify each person, including the name of parents, who has permission to pick up your child from the After School Program.
Authorized Person 1:

First NameLast Name
Phone Number 1:

Area CodePhone Number
Authorized Person 2:

First NameLast Name
Phone Number 2:

Area CodePhone Number
Authorized Person 3:

First NameLast Name
Phone Number 3:

Area CodePhone Number
Authorized Person 4:

First NameLast Name
Phone Number 4:

Area CodePhone Number
Statement of Policy
- Only persons authorized by the parent or guardian may pick up your child from the After School program.
- All students attending the After School Program are required to follow all school and program rules. Behavioral problems will result in parent notification and possible suspension from the program.
I have read and understand the Statement of Policy contained here.*

Agree
I give permission for my child to be transported by a representative of Veritas Academy for the After School Program*

Agree
My Products
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Registration Fee$30.00

Total $0.00
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After School Program Enrollment Form

Statement of Policy