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00-AftrSchl Application 2022- 23 Part-Time One Student

**FEE for PT ONE STUDENT $145 ($25 App + $120 PT PASS)

*Each card contains 5 passes

*USE or LOSE - At least one day must be used every 30 days.  If not used, a day will be deducted from your available number of passes.

*There are no refunds for passes purchased.

 The After School Enrichment Program runs from August 29, 2022 - June 09, 2023. 

The After School Enrichment Program is open to all students in Kindergarten through 6th grade (through 12 years of age).  Students are enrolled on a first-come, first serve basis. 

Below you will find links to the 2022-23 Parent Guide, Discipline Policy, and Child Care Laws.  Please be sure to read all forms and print the Parent Guide and Discipline Policy for future reference. 

Please read the following statements as you will be signing at the bottom of this form that you have read, understand and agree with these statements.

Parent Guide:  I have read and fully understand the Parent Guide, payment fees and rules and regulations of the program.  I agree that, if dropping from the program, I am required to give a two week PAID notice.

Discipline Policy and Chlid Care Laws:  I have read and fully understand the Discipline Policy and the Child Care Laws.

Parental Consent:  I hereby give consent for my child to participate in the Pitt County Community Schools and Recreation Summer Enrichment Program.  The information provided on this application is correct and complete.  While I realize that all precautions will be taken to guard my child from injury, I will not hold the Pitt County Board of Education, Community Schools and Recreation Program or program staff responsible for accidents that may occur.  I recognize and understand that participation in recreation activities may necessitate strenuous physical activity and could possibly activate any unrecognized pre-existing medical conditions.  I warrant and represent that my child is in good physical health and condition and is able to participate in this program.  I agree that the operator may authorize the physician of his/her choice to provide emergency care.

Photo Release:  Occasionally we may take photographs of the children in our program.  We may use these images in printed publications or on our website.  We will not release any personal details or names in our publications or website.

Other Information:

  • Please make sure you list all those who will have permission to pick up your child from our program.  If someone other than those listed will be picking up your child you will need to fax the information to our office before they will be allowed to do so. 
  • If any information concerning your child changes, please notify our office in order to keep your information updated.
  • Choose the correct status for your child. 
  •  Students may start the After-School program the 3rd business day after ALL applicable fees are paid.
Payment to: Pitt County Schools
Item Amount: $145.00
+ Additional Fees:
Convenience Fee $0.00
Item Total $145.00

Additional Information Requested

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