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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Parent/Guardian/Staff Name *
Address *
Email *
Phone Number *
Child's Name *
Child's Birthdate *
MM
/
DD
/
YYYY
Child's Age *
Child's Race (Please Select All That Apply) *
Required
Child's Ethnicity *
Days in Attendance (Please Select All That Apply) *
Required
Academic Information
Child's School *
Unlisted School Name:
Child's Grade 2021-2022 *
Grades
Overall Academics
Disabilities
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Does your child have any allergies or dietary restrictions?
Is there anything else that you would like us to know about your child?
Are you interested in any of our other programs?
How did you hear about us? *
Required
Are you interested in receiving financial assistance? *
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