Kingdom Community Services After School Program

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Here at KCS, we offer a variety of programs for your family needs. This form is for after school youth who needs ASSIST (Accelerated Study Sessions Including Scholars Talk). Once you complete this form, our Admin team will assist you with your next steps for the application process.

Email *

Record my email address with my response

Youth First Name *

Youth Last Name *

DOB *

YYYY

Youth Age *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email *

Parent/Guardian Phone Number *

What county does your youth reside? *

Does your youth have transportation to our afterschool program? *

Yes

Will your youth need transportation? *

Yes

What school does your youth attend? *

What grade is your youth currently in? *

List ways that we can assist your youth in this program. *

Submit

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