PHA School Year Registration

PHA 2024-2025 School Year Registration

PHACS begins on 9/3/24 for 1-6 grade.
Kindergarten begins on 9/5/24

Program Cost: $40 regular afterschool days and $60 for Early Release/Full Days. Vacation Weeks will be $300

Please fill out the Following Registration PDF (It is form fillable so it can be downloaded and filled in on your device, saved and emailed back or you can download, print it, fill it out and scan and email it back or bring it in) 

Please Email completed PDFs to Francesca Ciccone- [email protected]

PHA 24-25 School Year Registration PDF

Please Fill out the Form below to Pay the Deposit AFTER you fill out the PDF and Confirm your spot with Francesca

Parent/Guardian Name *

First

Last

Email *

Do you have a Voucher? *

• Yes
• No

How Many Children do you have attending the Program *

• 1
• 2
• 3
• 4

One Week Deposit *

Price: $220.00

One Week Deposit *

Price: $440.00

One Week Deposit *

Price: $660.00

One Week Deposit *

Price: $880.00

Card Info *

Card Number

MM123456789101112Expiration

/

YY2425262728293031323334

Security Code

Billing Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Signature *

Clear Signature

I acknowledge that this Deposit is Non-Refundable.

Total

$0.00

Submit