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Hope for Harvest Youth Center After-School Tutoring 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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* Indicates required question
Parent/Guardian/Staff Name
*
Your answer
Address
*
Your answer
Group Name (Groups Only)
*
Choose
Monteith
Jules
Twin
Swearngan
Troutman
No Group Association
Email
*
Your answer
Phone Number
*
Your answer
Child's Name
*
Your answer
Child's Birthdate
*
MM
/
DD
/
YYYY
Child's Age
*
Choose
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child's Race
*
Asian
African American/Black
American Indian or Alaska Native
Caucasian/White
Native Hawaiian or Pacific Islander
Required
Child's Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
Child's Afterschool Availability
*
Tuesdays 3:00 PM to 6:00 PM
Tuesdays 3:30 PM to 6:30 PM
Tuesdays 4:00 PM to 7:00 PM
Thursdays 3:00 PM to 6:00 PM
Thursdays 3:30 PM to 6:30 PM
Thursdays 4:00 PM to 7:00 PM
Other:
Required
Academic Information
Child's School
*
Alexander Youth Network
ARJ
Charlotte Academy
Biddleville School
Druid Hills Academy
Irwin Academic Center
Lincoln Heights Academy
Marshall Middle School
Martin Luther King Middle School
Morningside at Graham
Northwest School of the Arts
Walter G Byers Elementary
Myers Park High School
Oaklawn Language Academy
Seversville School
Warlick Middle School
Other School
Other:
Unlisted School Name:
Your answer
Child's Grade 2021-2022
*
Choose
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Grades
My child receives A's and B's in Math
My child receives a C or lower in Math
My child receives A's and B's in Reading/Language Arts
My child receives a C or lower in Reading/Language Arts
Other:
Overall Academics
My child would benefit from Math assistance with a tutor
My child would benefit from Reading assistance with a tutor
My child has been held back
My child is on track
Other:
Disabilities
My child has a disability
My child does not have a disablity
Other:
Clear selection
Does your child have any allergies or dietary restrictions?
Your answer
Is there anything else that you would like us to know about your child?
Your answer
Are you interested in any of our other programs?
Clothing Closet
Emergency Food Assistance
Summer Camp 2022!
Other:
How did you hear about us?
Yard sign
Banner on the youth center building
A flyer in my neighborhood
A flyer at my child(ren)'s school
Facebook
Instagram
Other:
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