Hunts Point Alliance for Children - Enrollment Form 2023-24
Please complete an enrollment form for each child participating in an HPAC program during the 2023-24 year. 
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FILL OUT THE BELOW SECTION FOR EACH CHILD. 
Choose an HPAC Program *
Student First Name  *
Student Last Name *
Birthdate *
MM
/
DD
/
YYYY
School Name
If your child is not in school please leave blank. 
Grade *
If your child is not in school please type None.
T-Shirt Size *
Allergies/Dietary Restrictions *
The information below will be used for grant reporting purposes. Hunts Point Alliance for Children does not discriminate based on race, color, religion, sex, sexual orientation, gender identity and expression, national origin, age, marital status, disability, veteran status, genetic information, or any other basis protected by relevant national and state law.  
Gender *
Race *
PARENT INFORMATION 
Information for parent/guardian will also be used to contact in case of an emergency. 
Parent First Name *
Parent Last Name *
Preferred Method of Contact *
Required
Relationship to Child *
Email *
Cell Number *
Work Number
HOUSEHOLD INFORMATION
Home Address *
City *
State *
Zip code *
Primary Language Spoken at Home *
Emergency Contact  Name *
Emergency Contact Phone *
Emergency Contact Preferred Language *
Would you like to be contacted by our Family Project Team? *
The Family Project works with families of children in HPAC programs to access free supportive services such as counseling services, housing support, academic support and other referrals. 
Required
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