Enrollment Request Form - Mosaic Afterschool Club - 2022-2023
Completion of the Enrollment Request Form will begin your Mosaic Afterschool Club Application process! Because our program has limited space, we expect that submission of this form indicates serious interest and full intent to enroll in the program if offered a spot.

If we have the spot available for your child, completion of this form will begin their enrollment. Invoices for a non-refundable deposit equal to two weeks tuition and an Enrollment Agreement will be sent to you by email.

If we do not have your requested days available, we will be in touch with you to discuss other options!

Please complete one form for EACH child in your family that you would like to enroll in Club!

For more information, please see www.creativesoulcamp.com/mosaic.

Email info@creativesoulcamp.com or text/call 802-242-1642 with any questions!
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Email *
PARENT First and Last Name *
CHILD First and Last Name *
CHILD Date of Birth *
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CHILD Age as of September 1, 2022. *
Elementary School and Grade for the 2022-2023 School Year *
Address *
Phone Number *
Are you submitting a separate Enrollment Request for another child in your family that we should link this form to? *
I confirm that I am enrolling my child for the Monroe Street Arts Center and/or Randall Elementary Location of Club (in Madison) AND for the current 2022-2023 school year! *
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