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Hope for Harvest Youth Center After-School Registration Form
Thank you for your interest in joining our community at Hope for Harvest!
Please fill out a registration form for each child who will be attending.
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* Indicates required question
Parent/Guardian/Staff Name
*
Your answer
Address
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Child's Name
*
Your answer
Child's Birthdate
*
MM
/
DD
/
YYYY
Child's Age
*
Choose
6
7
8
9
10
11
12
13
14
15
16
Child's Race (Please Select All That Apply)
*
Asian
African American/Black
American Indian or Alaska Native
Caucasian/White
Native Hawaiian or Pacific Islander
Required
Child's Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
Days in Attendance (Please Select All That Apply)
*
Monday
Wednesday
Friday
Other:
Required
Academic Information
Child's School
*
Alexander Youth Network
Allenbrook Elementary
ARJ
Ashley Park Elementary
Biddleville School
Bruns Avenue Elementary
Charlotte Academy
Druid Hills Academy
Highland Renaissance Academy
Lincoln Heights Academy
Marshall Middle School
Martin Luther King Middle School
Morningside at Graham
Myers Park High School
Northwest School of the Arts
Oaklawn Language Academy
Seversville School
Statesville Road Elementary
Walter G Byers Elementary
Warlick Middle School
Other School
Other:
Unlisted School Name:
Your answer
Child's Grade 2021-2022
*
Choose
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grades
My child receives A's and B's in Math
My child receives a C or lower in Math
My child receives A's and B's in Reading/Language Arts
My child receives a C or lower in Reading/Language Arts
Other:
Overall Academics
My child would benefit from Math assistance with a tutor
My child would benefit from Reading assistance with a tutor
My child has been held back
My child is on track
Other:
Disabilities
My child has a disability
My child does not have a disablity
Other:
Clear selection
Does your child have any allergies or dietary restrictions?
Your answer
Is there anything else that you would like us to know about your child?
Your answer
Are you interested in any of our other programs?
Clothing Closet
Emergency Food Assistance
Summer Camp 2023!
Thanksgiving Meal Supplies
Other:
How did you hear about us?
*
Yard Sign
Banner
A Flyer In My Neighborhood
A Flyer At My Child(ren)'s School
School Counselor
Virtual Flyer/Email
Other:
Required
Are you interested in receiving financial assistance?
*
No
Yes, I'd like to learn more
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