Activity Fee Letter and Form - Perkiomen Valley School District

Perkiomen Valley School DistrictLearners Today, Leaders TomorrowDear Perkiomen Valley Families,The Perkiomen Valley School District, like most school districts across the state, has beengreatly affected by the current downturn of the economy. So that we can continue to offerhigh quality athletic and extracurricular activities, the school district has established an activityfee for students in grades 7-12 who participate in a school activity.For the 2011-2012 school year, the activity fee is $50 per student with a maximum of $150per household. Payment of the fee will allow a student to participate in an unlimited numberof extracurricular activities and athletic programs during the 2011-2012 school year. The feewill help to offset the costs of coach/advisor stipends, transportation (to and from schools foractivity and athletic events), club fees, and equipment related to all extracurricular activitiesand athletic programs. This is an annual fee to support all PVSD activities; it is not just a feeto participate in an activity or sport.To see a list of extra-curricular activities and athletic programs for which the $50 activity feemust be paid, please visit http://lsurl.me/15H.We encourage you to complete the attached form and send in your payment to your child’sschool office or to our administrative offices as soon as possible. The deadline for feesubmission for fall activities is Friday, September 16, 2011. If your child does notparticipate and pay the fee in the fall, payment for winter or spring activities is due uponregistration.The Perkiomen Valley School District is committed to providing the finest education for ourstudents, and we believe that athletic programs and extra-curricular activities are importantaspects of a well-rounded education. We thank you for your cooperation as we continue towork together to provide our students with high quality programs in a way that is fiscallyresponsible to all taxpayers in the school district.Sincerely,Dr. Clifford RogersSuperintendent of SchoolsDr. Clifford Rogers, Superintendent • 3 Iron Bridge Drive • Collegeville, PA 19426P 610.489.8506, ext. 1111 • F 610.489.2974 • E crogers@pvsd.orgwww.pvsd.org

Perkiomen Valley School DistrictLearners Today, Leaders Tomorrow2011-2012 Student Activity FeeThe established Student Activity Fee for the 2011-2012 school year is $50 per student in grades 7-12. Thereis a maximum fee of $150 per family. Activities that will be assessed fees include all sports programs (bothinterscholastic and intramural) and non-graded activities such as band, chorus, school plays and musicals,and clubs. To see a list of extra-curricular activities and athletic programs for which the $50 activity fee mustbe paid, please visit http://lsurl.me/15H. Please complete the information below for each student, andindicate a minimum of one activity/sport/club that each child plans to participate in this year.Student Name: ___________________________________________________School: ____________________________Grade: _____________Activity/Sport/Club: ______________________________Student Name: ___________________________________________________School: _____________________________Grade: _____________Activity/Sport/Club: ______________________________Student Name: ___________________________________________________School: _____________________________Grade: _____________Activity/Sport/Club: _____________________________Family Address: _________________________________________________________________________I am submitting payment by:□ Cash □ Money order □ Check # ______ □ I am applying for a waiver (see back of thisform)________________________________________________________________________Signature of Students________________________________ ______________________________________Signature of Parent/GuardianPrinted Name of Parent/GuardianNote: I understand that the fee I am paying does not guarantee a specific role or position in a musical activity or club and thatresigning from an activity or club does not warrant a refund of the activity fee. In addition, paying the fee does not guaranteeplaying time or control over any condition of the team or program. The fee is not refundable once a position on a team issecured or participation in an activity has started. In addition, I understand that the fee will not be refunded or pro-rated if astudent becomes injured or ineligible during the season, when a student is removed from a team for academic or disciplinaryreasons, when cancelled contests cannot be rescheduled, or when a full allotment of games cannot be scheduled. I understandthat paying the fee does not alter the Student Athlete Policies of the Perkiomen Valley School District or the regulations of thePennsylvania Interscholastic Athletic Association and/or individual team or activity rules.InstructionsPlease complete this form, attach your payment (cash, money order, or check payable to PerkiomenValley School District), and return it to your child’s school office or to:Perkiomen Valley School DistrictAttn: Activity Fees3 Iron Bridge DriveCollegeville, PA 19426Write your child(ren)’s name and activity in the memo portion of the check. The deadline for feesubmission for fall activities is Friday, September 16, 2011.Please note: if your child(ren) qualifies for Free or Reduced Lunch, please follow the directions onthe back of this form to apply for a waiver.For Office Use OnlyCheck # _____________ Date Paid _________________ Date Entered ________________

Perkiomen Valley School DistrictLearners Today, Leaders TomorrowApplication for Waiver of Activity FeeIn order to receive a waiver of the Perkiomen Valley School District Activity Fee for your child(ren)for the 2011-2012 school year, one of the following must be attached. Please submit this formcompleted on both sides to:Perkiomen Valley School DistrictAttn: Activity Fees3 Iron Bridge DriveCollegeville, PA 19426□ Eligible for free or reduced lunch status (Apply online. See http://lsurl.me/167 for directions.)□ Activity fee not required due to maximum $150 fee per family□ None of the above, but I would like to request financial assistance based on the documentedstatement of need as indicated below. (Waivers will be determined at the discretion of buildingprincipal or school district administrator.)Statement of Need:I certify that the above information is truthful and accurate. I will notify the Superintendent’sOffice if my circumstances change.____________________________________Signature of Parent/Guardian__________________________________Printed Name of Parent/Guardian_________________________________________________________________________Address___________________________________Home Phone__________________________________Cell/Work Phone________________________________________________________________________Email AddressStudent(s) Name(s): _______________________________________ ______________________________School_______________________________________ ___________________________School_______________________________________ ___________________________School