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ENROLLMENT FORM
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Email
*
Your email
Please make sure to use a laptop or desktop computer while filling our enrollment form. We have had problems with the mobile version in the past. Thank you.
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Your answer
Child Information
First Name
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Your answer
Middle Name
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Your answer
Last Name
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Gender
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Female
Male
Non - conforming
Race and Ethnicity
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Your answer
Language(s) spoken at home
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Your answer
Parent / Guardian informations
First Name
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Your answer
Last Name
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Your answer
Relationship to child
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Your answer
Address
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Your answer
City
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Your answer
Cell Phone
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Your answer
Are you interested in a volunteer mentor opportunity in our program?
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Yes
No
I want to know more
Do you wish to apply for a scholarship?
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Yes
No
Please briefly state why you would like your child to attend this program.
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Your answer
How did you hear about us?
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Your answer
What is the best way to contact you upon receiving your enrollment application to meet with you and the applicant
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Phone call
Phone text
Email
Please note that there is a non-refundable enrollment application fee of $50 for the year (Link on the confirmation page). The first month of tuition is due by 07/01/2020 to secure your spot in our program.
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A copy of your responses will be emailed to the address you provided.
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