2010-2011 After School Program Application
Membership: (non refundable 12 month membership; must be a member to participate in any program):
$20/first child; $15/each additional child
Weekly Fees:
K‐5th graders:
Full time $49/week for the first child
$41/week for each sibling
Part time (3 days or less) $39/week for each sibling
6th‐12th graders
Full or part time $25/week
Holidays
Winter break, spring break and teacher workdays are $20/day
Limited financial assistance made possible by the Women’s Giving Circle
**See an administrative staff person for more information**
Schools
*Transportation is shared with the NW Boys and Girls Club; noted in bold.*
Elementary: Chiles, Glen Springs, Talbot, Hidden Oak, Terwilliger, Littlewood, Metcalfe, Norton, Rawlings, and Stephen Foster
Middle school: Ft. Clarke, Hoggetowne, Howard Bishop, Westwood
High School: transportation is not provided; most students rely on public transportation.
Additional schools will be considered for transportation if 5 or more families can commit for the entire school year.
Hours:
School Release – 6:00 p.m.
Activities:
Snack and free play, homework assistance (3:15‐4:00), structured group activities (4:00‐6:00)
Structured activities: athletics, character development, social and life skills
Groups:
Pink (K‐1st), Red (2nd‐3rd), Yellow (4th‐5th), Green (6th‐7th), Blue (8th‐12th)
Contact Information:
2101 NW 39th Avenue
Gainesville, Florida 32605
Main office phone: 352‐373‐4475
Program office phone: 352‐378‐8664
Fax: 352‐373‐5550
Program Director: Christi Arrington
programdirector@girlsplaceinc.org
-
First Child:
-
-
/
/
-
-
-
Second Child:
*Use if necessary, this form can be used to enroll up to three siblings.
-
-
/
/
-
-
-
Third Child:
*Use if necessary, this form can be used to enroll up to three siblings.
-
-
/
/
-
-
-
Address:
-
-
-
-
-
Parent Information:
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Pick Up Limitations
*Mother, Father, and Emergency Contact listed are assumed to be allowed pickup unless otherwise notified. You may fill in as many or few contacts as you need here.*
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Emergency Contact
-
-
-
-
-
-
The following information is optional and ONLY used to assist us in obtaining funding and various grants. THIS INFORMATION WILL BE HELD CONFIDENTIAL.
-
-
-
-
-
-
-
-
-
Medical Information:
-
-
-
-
-
-
/
/
-
-
-
-
-
Financial Need
-
-
-
Please type in your initials for the following statements.
By initialing below I, as the parent or legal guardian, acknowledge the following information or policies. I understand that my initials are not required for the photo release.
-
Initial Here
-
Initial Here
-
Initial Here
-
Initial Here
-
Initial Here
-
Initial Here
-
Questionnaire: (Please complete in an effort to provide the most positive experience for your children)
-
-
-
-
-
-
-
-
Signature:
-
-
-
