BGCHarlem Summer Enrollment Survey

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BGCHarlem Summer Enrollment Survey

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* Indicates required question

Child First Name *

Your answer

Child Last Name *

Your answer

Child Date of Birth *

MM

/

DD

/

YYYY

Child Grade Level for Fall 2020 *

Choose

K

1

2

3

4

5

6

7

8

Parent/Guardian First Name *

Your answer

Parent/Guardian Last Name *

Your answer

Phone Number *

Your answer

Email Address *

Your answer

Home Street Address *

Your answer

Home Zip Code *

Your answer

Financial Aid may be available. Do you qualify for SNAP Benefits or Public Assistance? *

Yes

No

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