2023-2024 After School Registration Form

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The Education Innovation Initiative After School Program

The Education Innovation Initiative After School Program does not discriminate against students based on race, ethnicity, color, ancestry, national origin, religion, immigration status, sex, gender, gender identity, gender expression, sexual orientation, family/parental status, marital status, age, physical or mental disability, poverty or socioeconomic status, language, or other legally and constitutionally protected attributes or affiliations.

Email *

Student Name *

Student Age *

Student Date of Birth *

YYYY

Parent/Guardian Name *

Parent/Guardian Phone Number *

Mailing Address *

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