2024-2025 Future Valley Academy After-school Program
Phone: 515-999-6888
Email:  futurevalleyacademy@gmail.com
Web: www.futurevalley.org
Address: 608 N El Camino Real, San Mateo CA 94401
Email *
2024 Future Valley Academy School Pickup Fees
Future Valley Academy 2024 School Calendar
Student's Name *
Student's Chinese Name
Are you a new student or returning student? *
Student's date of birth *
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Student's Current Age *
Home Language *
Gender *
Grade *
Day School Name *
Briefly describe your child's personality *
Home Address *
Mother's Name *
Phone *
Email *
Employer Name, Phone Number, and Address *
Father's Name *
Phone *
Email *
Employer Name, Phone Number, and Address *
Emergency Contacts
#1 Name *
#1 Phone *
Relationship *
#2 Name *
#2 Phone *
Relationship *
#3 Name
#3 Phone
Relationship
Name(s) of person(s) authorized to PICK UP the child from Future Valley Academy *
For the 2024-2025 After School program (beginning Tuesday, August 13, 2024), I am requesting the following schedule for my child: *
MEDICAL INFORMATION AND PARENT PERMISSIONS
Known Allergies *
Medical information *
1.EMERGENCY MEDICAL CARE: I give my consent for emergency medical care or treatment to be used only if I cannot be reached immediately at the phone number provided to Future Valley Academy. In case of emergency (accident or illness) and I cannot be reached, I give full permission to Future Valley Academy to transport my child to the nearest available health care facility. I will assume full responsibility (including financial responsibility) for services rendered. *
2. FIELD TRIPS: I understand that field trips (including swimming), by bus, by van, or on foot, are integral parts of the Future Valley Academy After School Program. I agree to allow my child to go on all field trips (including swimming) during the time she/he is enrolled in the Future Valley Academy Program. *
3. PHOTOGRAPHS or VIDEO: By choosing the “Yes” option below, I agree and consent to the use of any photographs or videos taken of persons under my guardianship. These pictures are understood to be used by Future Valley Academy for educational, advertising and publicity purposes only. This may include fliers, enrollment packets, the Future Valley Academy website Facebook or YouTube pages, etc. *
5. ​PAYMENT OF FEES​:
I agree to pay my tuition *
I would like an email bill reminder *
One time fees
1.Brightwheel Fee: $90 (Full School Year)
2.Materials Fee: $50 (English, Math, Friday Homework) (Full School Year)
3.Chinese books Fee: $80 (Full School Year)
4.New Student: Non-refundable registration fee $125 (Full School Year)
5.Returning Student: Non-refundable registration fee $100 (Full School Year)
6.Non-refundable deposit: $300 (Will be applied towards the first month's tuition)
AGREEMENT
I agree to provide at least 30 days’ prior written notice indicating my intention to withdraw my child(ren) from the after-school program, in which event I am entitled to receive the unused amount of any pre-paid tuition and fees in the form of school credits for my child(ren)’s participation in future enrichment classes or camp activities offered by Future Valley Academy, OR 70% of the unused amount of any pre-paid tuition and fees in cash. I agree to pay one additional month of tuition's and fees if I do not provide notice pursuant to the preceding sentence.

If any of my pre-paid tuition and fees is returned or refunded to me in the form of cash, school credits or otherwise for whatever reason, I agree to pay the tuition and fees for the enrichment classes or camps (including without limitation day camps, summer camps, winter camps and special program camps), at the then effective normal rates for such camps, that my child attended and in connection therewith has not paid the full tuition and fees due to special promotion program or otherwise.

I understand that my child(ren) are required to adhere to the rules and regulations of Future Valley Academy. Future Valley Academy reserves the right to terminate my child(ren) for inappropriate behaviors which continue to occur after two warnings, including without limitations, foul or derogatory language, verbal or physical abuse, bullying, behaviors that threatens the safety of others, possession or use of drugs, alcohol, tobacco, weapons or mock weapons, and other offenses in the sole discretion of Future Valley Academy. Upon such termination, I agree that I am not entitled to receive any refund or credit with respect to any fees or tuition paid in advance.

I agree to support FVA Services Program by encouraging children to abide by the highest standards of positive conduct. They will discuss constructive concerns, if any, regarding FVA Services Program, counselor or staff behavior, or company policies with FVA Services management. Parents agree to pay for property damage caused directly or indirectly as a result of the negligent action of my child(ren).

I understand that on No School Days and Early Release Days a separate registration is needed and an additional fee is required.
I agree *
Required
6. ​TEACHER COMMUNICATION ​: By enrolling my child in Future Valley Academy, I give permission to the Future Valley Academy staff to speak with day school staff to discuss matters related to my child. This permission is in effect until my child no longer attends the Future Valley Academy After School Program. *
7. ​ENROLLMENT AGREEMENT
Custodial parents & guardians must sign the Enrollment Form. Signatures at the bottom of this form are responsible for payment of all fees related to Future Valley Academy After-School Program.
Print Name *
Date *
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Permission and Release Agreement
Transportation Form
To better serve students and their families, Future Valley Academy (“FVA”) will provide transportation for students (a) from the student's’ school to FVA and (b) on field trips during FVA activities (collectively, “Transportation”). To receive Transportation, the student’s parent or legal guardian must execute the following agreement. As a part of these activities, there are times when staff and volunteers using their personal vehicles may transport students. If you would like your child to participate, please carefully read.

Please give FVA written 24-hour notice if your student will not attend class. If a 24-hour notice is not possible, FVA MUST be informed in writing that the pick-up will not be necessary. FVA reserves the right to assess a fee if changes must to be made to the schedule due to less than a 24-hour notice given to FVA (emergency situations are excluded)
1.SCHOOL TO FUTURE VALLEY ACADEMY TRANSFER: By signing this form I give Future Valley Academy permission to transport the Student from school to Future Valley Academy as well as on Future Valley Academy field trips. *
2. Release
This Release Agreement (“Release”) is a liability waiver, release and assumption of risk by the parent(s) or legal guardian(s) identified below (“Parent”) of any and all claims, demands, causes of action, or rights of action, present or future, known or unknown, anticipated or unanticipated, for direct, indirect or vicarious liability of any and all kinds (including negligence) directly or indirectly relating to or arising out of “Activities” specified below and the student(s) named above (“Student”). Parent hereby fully and forever releases and discharges Future Valley Academy (“FVA”) and its officers, directors, employees and agents (“Representatives”) from any and all liability (including negligence and product liability) relating in any way to such Activities. Parent hereby assumes all risks relating to such Activities, which may include injuries and losses of all kinds. This Release shall apply to all kinds of injuries and damages, including economic losses, physical or bodily injuries, permanent or disabling injuries, illness, death, mental or emotional injuries, damages, losses to possessions, whether accidental, deliberate, intentional or willful, whether or not caused by the negligence of FVA or its Representatives. Parent agrees that FVA makes no express or implied representation regarding the safety of the Activities. Due to the nature of the Activities, medical attention or care for personal injuries, sickness or accidents may not be immediately available.

This Transportation Waiver applies only to your child. Due to liability issues, your child is not permitted to transport any other student to and from school. That there is no school liability insurance or school vehicle insurance coverage for my child for this alternative to school transportation that I am choosing. Parent represents, as applicable, that the Student has had a competent determination made that Student is of good health and is medically competent to participate in the Activities. Parent and Student agree to comply with all rules concerning the Activities, whether posted, in writing, or otherwise provided. This Release shall be binding on the heirs, spouse, dependents, family members, assigns and all others who may assert a claim or demand or right by or through Parent or Student. FVA does not represent, and disclaims any representation, that it endorses or controls or in any way assures that such Activities will be safe or are not dangerous, and any contrary representation shall not be effective unless provided in writing by an officer of FVA. Parent agrees to indemnify and defend FVA and its Representatives against any claim, demand or assertion by any third party relating to the Activities. Parent agrees not to sue or bring suit or legal or equitable action against FVA or its Representatives for or on account of any losses, claims, cost, expenses or attorney fees arising out of any matter covered by the foregoing releases and indemnities. This Release is provided in exchange for consideration, the adequacy of which is acknowledged by Parent. This Release and rights hereunder may be assigned by FVA, and extends to FVA’s successors. Accordingly, I hereby waive this available school transportation for my child on a daily basis for the 2024-2025 school year.
Student Transportation as described above. *
Required
# 1 Signature of Parent or Legal Guardian (By entering my name below, I attest that I have read and understood the entirety of this enrollment form and that all information I provided is true and valid to the best of my knowledge.) *
# 1 Relationship *
Email *
Date *
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# 2 Signature of Parent or Legal Guardian (By entering my name below, I attest that I have read and understood the entirety of this enrollment form and that all information I provided is true and valid to the best of my knowledge.)
# 2 Relationship
Email
Date
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Do you want to be added to our waiting list if spots are full? *
Do you have any questions or requests?
A copy of your responses will be emailed to .
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