2026-2027 Before/After School Program

PAC Registration Form

COST OF CARE:

Registration Fee is $65 per student or $90 per family.

Full-Time "After School" Care (5 days/week: Monday- Friday)

Early Bird Pricing (May 1 - 31st): $21/Student/Day (Approximately $315/month over 12 Months)
Regular Pricing (Beginning June 1): $24/Student/Day (Approximately $360/month over 12 Months)

Part-Time "After School" Care (You choose the days you need care.)
*Please note you will be asked to select and commit to the specific days for which you need care if choosing this option.

4 Days/Week:
$28/Student/Day (Approximately $336/month over 12 Months)

3 Days/Week:
$28/Student/Day (Approximately $252/month over 12 Months)

2 Days/Week:
$32/Student/Day (Approximately $192/month over 12 Months)

1 Day/Week:
$32/Student/Day (Approximately $96/month over 12 Months)

All fees and payments are billed through FACTS.

Student Information

Student's First Namerequired

Student's Last Namerequired

Grade (Fall 2026) & Teacherrequired

Family Information

Mother's First Name

Mother's Last Name

Address 1

Address 2

City

State

Zip

Mother's Cell #

Mother's Work #

Ext

Mother's Emailrequired

Father's First Name

Father's Last Name

Father's Cell #

Father's Work #

Ext

Father's Email

Is Father's address the same as Mother's?

Yes

Please provide Father's address.

Address 1

Address 2

City

State

Zip

Emergency Contact

Emergency Contact Name (Other than parent)required

Relationship to Childrequired

Emergency Contact Phonerequired

Please list any known allergies:

Allergies

Medications - (EpiPen)

Authorized to Pick-Up: ID is required at Pick-Up

Please list name and relationship to child.

Name & Relationship to Child

Please Select Desired Services:

AFTER School - Do you need PAC after school?

Yes

AFTER School - Please Select Your Preference for After School PAC

Full Time

Part Time

AFTER School - Full Time Pricing:

Early Bird Pricing (May 1 - 31st): $3780 (Approximately $315/month over 12 Months)

Regular Pricing (Beginning June 1): $4320 (Approximately $360/month over 12 Months)

AFTER School - Part Time Pricing (Specific Set Days)

I agree to the Terms of Service

Parents/guardians/siblings who are dropping off participating PAC students between 7:00-7:29am (Mon,Tue,Thu,Fri) and between 7:00-8:00am (Wed) must drop them off at the entrance to Gym 2.

• Throughout the year, elementary students are dismissed at noon on specific dates. PAC will be offered on those dates, for an additional $35/Student fee. A registration form will be sent out in advance.

• My child(ren) will not be allowed to enter the facility unless escorted by the parent(s), person(s) as authorized above, or PAC Personnel. Please note: An ID is required for pick-up. Fellowship Carpool card tags must be in the car for pick-up. Please be aware that an ID is necessary for pick-up. Make sure card tags are displayed in the car. An announcement will be made upon arrival on site via PikMyKid.

• I acknowledge it is my responsibility to keep all records updated to reflect any changes to the PAC Director.

• PAC personnel will inform me of any incident, including illness, injury, or exposure to communicable diseases, which may affect my child(ren).

• Parents of children who participate in the program are required to read the PAC Program Policies available on the website. PAC follows the behavior and discipline policies in the Fellowship Elementary policy guide. Yellow slips will be used to communicate with families.

• All fees will be billed monthly through FACTS. Once registered, your child is signed up for the school year. Any changes requests must be sent to PAC Director, Lindsey Ashby. Your billing will start the next month in FACTS. No refund will be given to registered students who are absent from the program.

• I will send a healthy (peanut free) snack and water bottle for my child(ren) on days they stay for afternoon PAC.

Today's Date

Please use M/D/YYYY format. (Must contain a date in MM/DD/YYYY format)

Please Type Full Name